1841499183 NPI number — ROBERT S BAKER MD LTD

Table of content: (NPI 1841499183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841499183 NPI number — ROBERT S BAKER MD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT S BAKER MD LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1841499183
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4160 RT 83
Provider Second Line Business Mailing Address:
STE #106
Provider Business Mailing Address City Name:
LONG GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60047-5083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-955-1139
Provider Business Mailing Address Fax Number:
815-955-1139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4160 RT 83
Provider Second Line Business Practice Location Address:
STE #106
Provider Business Practice Location Address City Name:
LONG GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60047-5083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-955-1139
Provider Business Practice Location Address Fax Number:
815-955-1139
Provider Enumeration Date:
07/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FIELDS
Authorized Official First Name:
FAYE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
815-356-1559

Provider Taxonomy Codes

  • Taxonomy code: 2084P0805X , with the licence number:  036058454 , 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: 036058454 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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