Provider Demographics
NPI:1053590042
Name:BAKER FOOT SOLUTIONS CORP
Entity type:Organization
Organization Name:BAKER FOOT SOLUTIONS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-863-2556
Mailing Address - Street 1:PO BOX 330
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-0330
Mailing Address - Country:US
Mailing Address - Phone:317-863-2556
Mailing Address - Fax:317-203-0420
Practice Address - Street 1:1380 CHESTER BLVD
Practice Address - Street 2:STE C
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1907
Practice Address - Country:US
Practice Address - Phone:765-965-3668
Practice Address - Fax:765-965-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000796A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty