Provider Demographics
NPI:1760483911
Name:BAKER, MICHAEL CURTIS (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CURTIS
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 N DONNELLY ST
Mailing Address - Street 2:STE 103
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2846
Mailing Address - Country:US
Mailing Address - Phone:352-383-0624
Mailing Address - Fax:352-383-0758
Practice Address - Street 1:1502 N DONNELLY ST
Practice Address - Street 2:STE 103
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2846
Practice Address - Country:US
Practice Address - Phone:352-383-0624
Practice Address - Fax:352-383-0758
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 82068208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277033OtherAVMED PROVIDER ID
FL4543603OtherAETNA PROVIDER ID
FL5789736-007OtherCIGNA PROVIDER ID
FL01857OtherBCBS PROVIDER ID
FL01857OtherBCBS PROVIDER ID