Provider Demographics
NPI:1922119411
Name:BAAKLINI, MICHAEL Y (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:Y
Last Name:BAAKLINI
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 1:812 METACOM AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-5160
Mailing Address - Country:US
Mailing Address - Phone:401-253-0025
Mailing Address - Fax:401-253-0095
Practice Address - Street 1:812 METACOM AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-5160
Practice Address - Country:US
Practice Address - Phone:401-253-0025
Practice Address - Fax:401-253-0095
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07640207RG0300X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9002523Medicaid
119002523Medicare ID - Type Unspecified
RI9002523Medicaid