Provider Demographics
NPI:1548829898
Name:BAKER, MELISSA A (DO)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:BAKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1671 PRAIRIEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MI
Mailing Address - Zip Code:49078-9321
Mailing Address - Country:US
Mailing Address - Phone:586-854-5807
Mailing Address - Fax:
Practice Address - Street 1:521 E MICHIGAN AVE STE 201
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3889
Practice Address - Country:US
Practice Address - Phone:269-349-6759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101027881207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology