Provider Demographics
NPI:1518167295
Name:MACHHADIEH, BAKER (MD)
Entity Type:Individual
Prefix:
First Name:BAKER
Middle Name:
Last Name:MACHHADIEH
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 1:150 HIGH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-2725
Mailing Address - Country:US
Mailing Address - Phone:513-273-9220
Mailing Address - Fax:513-894-0012
Practice Address - Street 1:150 HIGH ST
Practice Address - Street 2:SUITE B
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-2725
Practice Address - Country:US
Practice Address - Phone:513-273-9220
Practice Address - Fax:513-894-0012
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085303207R00000X
OH35.126326207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000951720OtherANTHEM
OH0141816Medicaid
OHH402701Medicare PIN
OHH402700Medicare PIN