Provider Demographics
NPI:1639126014
Name:BAKER, STACEY E (MD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:E
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7800 SW 87TH AVE
Mailing Address - Street 2:STE B260
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3570
Mailing Address - Country:US
Mailing Address - Phone:305-595-4590
Mailing Address - Fax:305-279-2278
Practice Address - Street 1:7800 SW 87TH AVE
Practice Address - Street 2:STE B260
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3570
Practice Address - Country:US
Practice Address - Phone:305-595-4590
Practice Address - Fax:305-279-2278
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2011-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA227954207R00000X
FLME 103437207R00000X
FLME103437207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCI001ZMedicare PIN