Provider Demographics
NPI:1316129695
Name:BAKI, HUSAM (MD)
Entity type:Individual
Prefix:DR
First Name:HUSAM
Middle Name:
Last Name:BAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HUSAM
Other - Middle Name:
Other - Last Name:ABDULBAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:50925 SAFARI DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-6737
Mailing Address - Country:US
Mailing Address - Phone:312-451-4630
Mailing Address - Fax:
Practice Address - Street 1:1331 STATE ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3112
Practice Address - Country:US
Practice Address - Phone:219-326-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056375A207RA0201X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200383950Medicaid
IN000000940640OtherBCBS
INE62211Medicare UPIN
IN200383950Medicaid
IN000000940640OtherBCBS