1285686659 NPI number — JAMES BAIRD DPM

Table of content: JAMES BAIRD DPM (NPI 1285686659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285686659 NPI number — JAMES BAIRD DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAIRD
Provider First Name:
JAMES
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1285686659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1410 S. BARRINGTON ROAD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
BARRINGTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-381-5011
Provider Business Mailing Address Fax Number:
847-381-5052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1410 S. BARRINGTON ROAD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
BARRINGTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-381-5011
Provider Business Practice Location Address Fax Number:
847-381-5052
Provider Enumeration Date:
05/16/2006

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: 213ES0103X , with the licence number:  016-003540 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 016005120 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60001380 . This is a "BCBC OF ILLIONOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 480020436 . This is a "MEDICARE RR PROVIDER #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: CE8840 . This is a "MEDICARE RR GROUP #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0707390001 . This is a "DMERC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00383534 . This is a "MEDICARE RR PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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