Provider Demographics
NPI:1013392547
Name:BAKER, CALEB (PA)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 E MICHIGAN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1853
Mailing Address - Country:US
Mailing Address - Phone:517-841-1431
Mailing Address - Fax:517-841-1432
Practice Address - Street 1:1201 E MICHIGAN AVE STE 300
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1853
Practice Address - Country:US
Practice Address - Phone:517-841-1431
Practice Address - Fax:517-841-1432
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant