Provider Demographics
NPI:1679672372
Name:BAKER, JR., GEORGE H (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:H
Last Name:BAKER, JR.
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2909 E GRAND RIVER AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4300
Mailing Address - Country:US
Mailing Address - Phone:517-487-4480
Mailing Address - Fax:517-487-0193
Practice Address - Street 1:2909 E GRAND RIVER AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4300
Practice Address - Country:US
Practice Address - Phone:517-487-4480
Practice Address - Fax:517-487-0193
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010284042080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103182220Medicaid