Provider Demographics
NPI:1720064629
Name:BAKER, KIM B (MD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:B
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 E GEDDES AVE
Mailing Address - Street 2:NO 200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3800
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:501 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2702
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE250242085R0202X
KS04-366042085R0202X
HIMD176552085R0202X
CO407372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200240900AMedicaid
MI104686024Medicaid
IA1720064629Medicaid
KS200426720AMedicaid
CO300132610OtherRIA RR MCRE
AKMD227COMedicaid
TX3103277Medicaid
AZ920654Medicaid
NEP00720362OtherRR MCR NE
HI0000343772OtherHMSA ALL PRODUCTS
PA001590411Medicaid
MT1720064629Medicaid
CO63305704Medicaid
NE84-059792913Medicaid
NE10025709000Medicaid
WY1720064629Medicaid
NV1720064629Medicaid
CO300132612OtherMIC RR MCRE
NM57050791Medicaid
CAXPY202416Medicaid
KS200426720AMedicaid
NENA1214019Medicare PIN
COCO303820Medicare PIN
OK200240900AMedicaid
MI104686024Medicaid
KS111257023Medicare PIN
COC464718Medicare PIN
HI0000343772OtherHMSA ALL PRODUCTS
CAXPY202416Medicaid
NENA1215019Medicare PIN
CO420034ZLJ3Medicare PIN
COF85347Medicare UPIN
NM57050791Medicaid
NV1720064629Medicaid