Provider Demographics
NPI:1578579546
Name:BAACH, MICHAEL L (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:BAACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6626 E. 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-6333
Mailing Address - Fax:317-621-6310
Practice Address - Street 1:13050 PARKSIDE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-8247
Practice Address - Country:US
Practice Address - Phone:317-621-6300
Practice Address - Fax:317-621-6310
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01040531A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000312976OtherANTHEM
INP00082854OtherMEDICARE RAILROAD
IN200007440Medicaid
IN215270AMedicare PIN
IN000000312976OtherANTHEM
IN200007440Medicaid