Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 04-24544 | KS |
NPI | 1891883120 |
---|---|
Provider Name | Michael P Baker |
First Address | Pittsburg, KS 66762 |
Second Address | Pittsburg, KS 66762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 06/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
054383 | BCBS INDIVIDUAL (01) | KS |
110440 | BCBS GROUP (01) | KS |
F61879 | (02) | KS |