Provider Demographics
NPI:1538271267
Name:BAKER, KEITH R (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:R
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-8314
Mailing Address - Country:US
Mailing Address - Phone:517-439-0200
Mailing Address - Fax:517-439-1050
Practice Address - Street 1:1456 HUDSON RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-8314
Practice Address - Country:US
Practice Address - Phone:517-439-0200
Practice Address - Fax:517-439-1050
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKB041163207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0300044OtherBC NETWORK
MI1103001371OtherBCBSM
MI4646860Medicaid
MI1103001371OtherBCBSM
MI0N98940Medicare ID - Type Unspecified