Provider Demographics
NPI:1154366607
Name:BAACKE, KERI ANN (MD)
Entity type:Individual
Prefix:DR
First Name:KERI
Middle Name:ANN
Last Name:BAACKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:ANN
Other - Last Name:BAACKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2415 N ORANGE AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5505
Mailing Address - Country:US
Mailing Address - Phone:407-622-0560
Mailing Address - Fax:407-622-0563
Practice Address - Street 1:2415 N ORANGE AVE STE 402
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5505
Practice Address - Country:US
Practice Address - Phone:407-622-0560
Practice Address - Fax:407-622-0563
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90465207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270175800Medicaid