Provider Demographics
NPI:1992229199
Name:BAKI.L.L.C
Entity type:Organization
Organization Name:BAKI.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HUSAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-806-2626
Mailing Address - Street 1:786 MCCOOL RD STE 6
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8894
Mailing Address - Country:US
Mailing Address - Phone:574-806-2626
Mailing Address - Fax:
Practice Address - Street 1:786 MCCOOL RD STE 6
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-8894
Practice Address - Country:US
Practice Address - Phone:574-806-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty