Provider Demographics
NPI:1306065826
Name:BAKER BARIATRICS, LLC
Entity type:Organization
Organization Name:BAKER BARIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-236-2180
Mailing Address - Street 1:500 OSBORNE RD NE STE 125
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2767
Mailing Address - Country:US
Mailing Address - Phone:763-236-2180
Mailing Address - Fax:763-420-0500
Practice Address - Street 1:500 OSBORNE RD NE STE 125
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2767
Practice Address - Country:US
Practice Address - Phone:763-236-2180
Practice Address - Fax:763-420-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNG90837Medicare UPIN
MNC04609Medicare PIN