Basic Information
Provider Information
NPI: 1306838180
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAKER
FirstName: ROBERT
MiddleName: LOVE
NamePrefix:  
NameSuffix: II
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1001 BELLEFONTAINE AVE
Address2:  
City: LIMA
State: OH
PostalCode: 458042800
CountryCode: US
TelephoneNumber: 4199984575
FaxNumber: 4199984586
Practice Location
Address1: 1003 BELLEFONTAINE AVE STE 125
Address2:  
City: LIMA
State: OH
PostalCode: 458041867
CountryCode: US
TelephoneNumber: 4199988207
FaxNumber: 4199988216
Other Information
ProviderEnumerationDate: 08/18/2005
LastUpdateDate: 12/29/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/29/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207T00000X007874MIN Allopathic & Osteopathic PhysiciansNeurological Surgery 
207T00000X0S-005472-LPAN Allopathic & Osteopathic PhysiciansNeurological Surgery 
207T00000X34.003216OHY Allopathic & Osteopathic PhysiciansNeurological Surgery 

No ID Information.


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