Basic Information
| Provider Information | |||||||||
| NPI: | 1578579546 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAACH | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6626 E. 75TH STREET | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176216333 | ||||||||
| FaxNumber: | 3176216310 | ||||||||
| Practice Location | |||||||||
| Address1: | 13050 PARKSIDE DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | FISHERS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460388247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176216300 | ||||||||
| FaxNumber: | 3176216310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 09/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01040531A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000312976 | 01 | IN | ANTHEM | OTHER | P00082854 | 01 | IN | MEDICARE RAILROAD | OTHER | 200007440 | 05 | IN | MEDICAID |