Provider Demographics
NPI:1356359459
Name:BAKER, MICHAEL L (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:BAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-1602
Mailing Address - Country:US
Mailing Address - Phone:231-288-6383
Mailing Address - Fax:
Practice Address - Street 1:2005 ADDISON ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-1602
Practice Address - Country:US
Practice Address - Phone:231-288-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014644207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200811270AMedicaid
IN000000383679OtherBC/BS
IN247260Medicare PIN
IN000000383679OtherBC/BS
INH53952Medicare UPIN
IN200811270AMedicaid