Provider Demographics
NPI:1306589122
Name:BAKER, GEORGE HAROLD IV
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:HAROLD
Last Name:BAKER
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HAL
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3486 SHAKESPEARE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1489
Mailing Address - Country:US
Mailing Address - Phone:248-930-7679
Mailing Address - Fax:
Practice Address - Street 1:6071 W OUTER DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2624
Practice Address - Country:US
Practice Address - Phone:313-577-7523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program