Provider Demographics
NPI:1831546142
Name:BAKER, JOEL
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JOEL
Other - Middle Name:MIKUS
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AA
Mailing Address - Street 1:799 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1906
Mailing Address - Country:US
Mailing Address - Phone:419-756-5133
Mailing Address - Fax:
Practice Address - Street 1:799 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1906
Practice Address - Country:US
Practice Address - Phone:419-756-5133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant