Provider Demographics
NPI:1962608240
Name:BAKER, BRIAN LEE (CPED)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:LEE
Last Name:BAKER
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4938
Mailing Address - Country:US
Mailing Address - Phone:765-282-9187
Mailing Address - Fax:
Practice Address - Street 1:413 S TILLOTSON AVE STE 4
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4368
Practice Address - Country:US
Practice Address - Phone:765-281-8900
Practice Address - Fax:765-281-8999
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment