Provider Demographics
NPI:1821059502
Name:BAK, MALGORZATA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MALGORZATA
Middle Name:A
Last Name:BAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARGARET
Other - Middle Name:A
Other - Last Name:BAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5334 MEADOW LANE COURT
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1469
Mailing Address - Country:US
Mailing Address - Phone:440-282-7411
Mailing Address - Fax:440-282-7419
Practice Address - Street 1:5334 MEADOW LANE COURT
Practice Address - Street 2:
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44035-1469
Practice Address - Country:US
Practice Address - Phone:440-934-5454
Practice Address - Fax:440-934-8979
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-084892207Q00000X
OH35.084892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1003027OtherQUALCHOICE
OH2502125Medicaid
OH341908694031OtherCARESOURCE
OH7475629OtherAETNA
OH000000345924OtherANTHEM
OH2502125Medicaid
OHI17220Medicare UPIN
OHBA4142922Medicare PIN