Provider Demographics
NPI:1821057985
Name:BAKER, HAROLD G (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:G
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 1:12524 SOUTHEASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46259-1152
Mailing Address - Country:US
Mailing Address - Phone:317-862-2277
Mailing Address - Fax:317-862-9160
Practice Address - Street 1:12524 SOUTHEASTERN AVENUE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46259
Practice Address - Country:US
Practice Address - Phone:317-862-2277
Practice Address - Fax:317-862-9160
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032300A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100238270AMedicaid
IN100238270AMedicaid
IN100238270AMedicaid