Provider Demographics
NPI:1285625210
Name:BAKER, SCOTT ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALAN
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 N EUCLID AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2483
Mailing Address - Country:US
Mailing Address - Phone:989-684-4400
Mailing Address - Fax:989-684-0560
Practice Address - Street 1:4175 N EUCLID AVE STE 10
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2483
Practice Address - Country:US
Practice Address - Phone:989-684-4400
Practice Address - Fax:989-684-0560
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053017207Y00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI04000923042OtherBCBSM PIN
0400910811OtherBCBSM PIN
MI4954125Medicaid
MI3043790Medicaid
MI0400923042OtherHEALTHPLUS PROVIDER ID
P39670001Medicare PIN
MIF55455Medicare UPIN
MI3043790Medicaid