Basic Information
| Provider Information | |||||||||
| NPI: | 1275696635 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | R G BAKER DO PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7226 ALLEN RD | ||||||||
| Address2: | |||||||||
| City: | ALLEN PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481012060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133835530 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7226 ALLEN RD | ||||||||
| Address2: | |||||||||
| City: | ALLEN PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481012060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133835530 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2006 | ||||||||
| LastUpdateDate: | 05/01/2009 | ||||||||
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| AuthorizedOfficialLastName: | BAKER | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3133835530 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30516671755360 | 05 | MI | MEDICAID | 4204573 | 05 | MI | MEDICAID | 30516581713306 | 05 | MI | MEDICAID | 4120698 | 05 | MI | MEDICAID |