1285625210 NPI number — DR. SCOTT ALAN BAKER MD

Table of content: DR. SCOTT ALAN BAKER MD (NPI 1285625210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285625210 NPI number — DR. SCOTT ALAN BAKER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
SCOTT
Provider Middle Name:
ALAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285625210
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4175 N EUCLID AVE
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
BAY CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48706-2483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-684-4400
Provider Business Mailing Address Fax Number:
989-684-0560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4175 N EUCLID AVE STE 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48706-2483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-684-4400
Provider Business Practice Location Address Fax Number:
989-684-0560
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  4301053017 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: 4301053017 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04000923042 . This is a "BCBSM PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0400910811 . This is a "BCBSM PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4954125 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3043790 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0400923042 . This is a "HEALTHPLUS PROVIDER ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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