Provider Demographics
NPI:1578764254
Name:HERBERT L BAKER MD PLC
Entity Type:Organization
Organization Name:HERBERT L BAKER MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-342-9820
Mailing Address - Street 1:PO BOX 2220
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-2220
Mailing Address - Country:US
Mailing Address - Phone:248-557-2900
Mailing Address - Fax:248-557-2903
Practice Address - Street 1:20905 GREENFIELD RD
Practice Address - Street 2:SUITE 701
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5360
Practice Address - Country:US
Practice Address - Phone:248-557-2900
Practice Address - Fax:248-557-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P16620Medicare PIN
MI0P16620Medicare ID - Type Unspecified