Provider Demographics
NPI:1558390435
Name:BAKER FOOT SOLUTIONS CORP
Entity Type:Organization
Organization Name:BAKER FOOT SOLUTIONS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-863-2556
Mailing Address - Street 1:PO BOX 330
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-0330
Mailing Address - Country:US
Mailing Address - Phone:317-863-2556
Mailing Address - Fax:317-203-0420
Practice Address - Street 1:1622 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-2130
Practice Address - Country:US
Practice Address - Phone:765-641-0001
Practice Address - Fax:765-641-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200513150AMedicaid
IN200513150EMedicaid
IN200513150DMedicaid
000000360213OtherBLUE CROSS
IN200513150FMedicaid
IN200513150GMedicaid
IN200513150CMedicaid
DD2888OtherRR MEDICARE
IN200513150FMedicaid
223300Medicare PIN