Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 23935 | NE |
N | 111NI0900X | Internist | 23935 | NE |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 23935 | NE |
N | 207RC0000X | Internist - Cardiovascular Disease | 23935 | NE |
NPI | 1093936429 |
---|---|
Provider Name | Dr. Mathue Michael Baker |
First Address | Lincoln, NE 68506-0607 |
Second Address | Lincoln, NE 68506-1275 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 10/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093936429 | (05) | IA |
23935 | MEDICAL LICENSE (01) | NE |
47084496100 | (05) | NE |