Basic Information
| Provider Information | |||||||||
| NPI: | 1831319516 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAIDOO | ||||||||
| FirstName: | EMMANUEL | ||||||||
| MiddleName: | KWAME | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 N WATERMAN AVE | ||||||||
| Address2: | #47 | ||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924045115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9518058575 | ||||||||
| FaxNumber: | 8667170903 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 N WATERMAN AVE | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924045115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098838611 | ||||||||
| FaxNumber: | 9098861798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 08/02/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A9954 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.