Provider Demographics
NPI:1285212712
Name:TILLER-BAKER, MARIAH HAYLEE (DO)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:HAYLEE
Last Name:TILLER-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 1:534 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-1296
Mailing Address - Country:US
Mailing Address - Phone:270-422-5000
Mailing Address - Fax:270-422-5052
Practice Address - Street 1:534 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1296
Practice Address - Country:US
Practice Address - Phone:270-422-5000
Practice Address - Fax:270-422-5052
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine