Provider Demographics
NPI:1841499183
Name:ROBERT S BAKER MD LTD
Entity type:Organization
Organization Name:ROBERT S BAKER MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-356-1559
Mailing Address - Street 1:4160 RT 83
Mailing Address - Street 2:STE #106
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-5083
Mailing Address - Country:US
Mailing Address - Phone:847-955-1139
Mailing Address - Fax:815-955-1139
Practice Address - Street 1:4160 RT 83
Practice Address - Street 2:STE #106
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-5083
Practice Address - Country:US
Practice Address - Phone:847-955-1139
Practice Address - Fax:815-955-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360584542084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058454Medicaid
IL036058454Medicaid
ILK07926Medicare PIN
ILD89400Medicare UPIN