Provider Demographics
NPI:1861492571
Name:BAKER, ABBEY J (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ABBEY
Middle Name:J
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ABBEY
Other - Middle Name:J
Other - Last Name:KIEFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4400 W 95TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2654
Mailing Address - Country:US
Mailing Address - Phone:708-346-4040
Mailing Address - Fax:708-346-3287
Practice Address - Street 1:4400 W 95TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2654
Practice Address - Country:US
Practice Address - Phone:708-346-4040
Practice Address - Fax:708-346-3287
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001278363AS0400X
IN10000448A363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01618941OtherBLUECROSS/BLUESHIELD
IN970022851Medicare PIN
ILP03813Medicare UPIN
ILL81738Medicare PIN
IL01618941OtherBLUECROSS/BLUESHIELD
IL970028311Medicare PIN
IL970013773Medicare PIN
IN408430LMedicare PIN