Provider Demographics
NPI:1356570428
Name:BABA, MICHAEL JOHN (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:BABA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 OSTRUM ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:484-526-7888
Mailing Address - Fax:484-526-6998
Practice Address - Street 1:487 E MOORESTOWN RD
Practice Address - Street 2:SUITE #101
Practice Address - City:WIND GAP
Practice Address - State:PA
Practice Address - Zip Code:18091-9662
Practice Address - Country:US
Practice Address - Phone:484-526-7888
Practice Address - Fax:484-526-6998
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017181207Q00000X
390200000X
NY259515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program