Provider Demographics
NPI:1619069523
Name:BAKER EAR NOSE & THROAT ASSOCIATES PLC
Entity Type:Organization
Organization Name:BAKER EAR NOSE & THROAT ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-684-4400
Mailing Address - Street 1:4175 N EUCLID
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706
Mailing Address - Country:US
Mailing Address - Phone:989-684-4400
Mailing Address - Fax:989-684-0560
Practice Address - Street 1:4175 N EUCLID
Practice Address - Street 2:SUITE 10
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706
Practice Address - Country:US
Practice Address - Phone:989-684-4400
Practice Address - Fax:989-684-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053017207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3043790Medicaid
MI0400910811OtherBLUE CROSS BLUE SHIELD
MI0400923042OtherHEALTHPLUS PROVIDER ID
MI1619069523OtherGROUP NPI NUMBER
MN1285625210OtherINDIVIDUAL NPI NUMBER
MIF55455Medicare UPIN