Provider Demographics
NPI:1205219300
Name:BAKER, GAYATRI KOLLURU (DO)
Entity type:Individual
Prefix:
First Name:GAYATRI
Middle Name:KOLLURU
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 1:2050 LARKIN AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5899
Mailing Address - Country:US
Mailing Address - Phone:478-697-2400
Mailing Address - Fax:847-697-2438
Practice Address - Street 1:2050 LARKIN AVE STE 202
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5899
Practice Address - Country:US
Practice Address - Phone:478-697-2400
Practice Address - Fax:847-697-2438
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250671942084P0800X
IL0361460172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry