Provider Demographics
NPI:1568605616
Name:BAKE, WILLIAM PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PAUL
Last Name:BAKE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3805B SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1641
Mailing Address - Country:US
Mailing Address - Phone:262-687-8322
Mailing Address - Fax:262-687-6107
Practice Address - Street 1:3805B SPRING ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53405-1641
Practice Address - Country:US
Practice Address - Phone:262-687-8322
Practice Address - Fax:262-687-6107
Is Sole Proprietor?:No
Enumeration Date:2009-04-18
Last Update Date:2015-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI555962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400148118Medicare PIN