Provider Demographics
NPI:1891883120
Name:BAKER, MICHAEL P (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
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 1:107 N PINE
Mailing Address - Street 2:PO BOX 1628
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762
Mailing Address - Country:US
Mailing Address - Phone:620-232-7500
Mailing Address - Fax:620-231-7501
Practice Address - Street 1:107 N PINE
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762
Practice Address - Country:US
Practice Address - Phone:620-232-7500
Practice Address - Fax:620-231-7501
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24544207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS054383OtherBCBS INDIVIDUAL
KS110440OtherBCBS GROUP
KS054383OtherBCBS INDIVIDUAL
KS110440Medicare ID - Type UnspecifiedMEDICARE GROUP
KSF61879Medicare UPIN