Basic Information
| Provider Information | |||||||||
| NPI: | 1760477608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BACKER | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | LEWIS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3333 BURNET AVE | ||||||||
| Address2: | MLC 2004 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452293026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136364770 | ||||||||
| FaxNumber: | 5136363847 | ||||||||
| Practice Location | |||||||||
| Address1: | UK HEALTHCARE 740 S LIMESTONE SUITE A301 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405362991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593236494 | ||||||||
| FaxNumber: | 8592574682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2005 | ||||||||
| LastUpdateDate: | 08/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 35.139651 | OH | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | TP117 | KY | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 53982 | KY | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 036064156 | IL | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 036064156 | 05 | IL | MEDICAID | 05825879 | 05 | MS | MEDICAID | 1627123 | 01 | IL | BCBS PROVIDER ID | OTHER | 363283051 | 01 | IL | OWCP PROVIDER ID | OTHER | 6435508 | 05 | KY | MEDICAID |