Provider Demographics
NPI:1205916475
Name:BAKER, SUSAN L (DO)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:BAKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:NAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5070 CASCADE RD SE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8422
Mailing Address - Country:US
Mailing Address - Phone:616-281-9066
Mailing Address - Fax:616-281-0539
Practice Address - Street 1:5070 CASCADE RD SE
Practice Address - Street 2:SUITE 250
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8422
Practice Address - Country:US
Practice Address - Phone:616-281-9066
Practice Address - Fax:616-281-0539
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009361207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E57679Medicare UPIN
MIP27140002Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER