Provider Demographics
NPI:1518029701
Name:BAKER, EDWARD KIRK (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:KIRK
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 BEVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455
Mailing Address - Country:US
Mailing Address - Phone:309-837-3663
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY CIRCLE
Practice Address - Street 2:BEU HEALTH CENTER
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-1390
Practice Address - Country:US
Practice Address - Phone:309-298-1888
Practice Address - Fax:309-298-2188
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB6367610OtherDEA
D09874Medicare UPIN