Provider Demographics
NPI:1366407413
Name:BAKER, DALE E (MD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:E
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3145 W CLARK RD
Mailing Address - Street 2:STE 401
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1120
Mailing Address - Country:US
Mailing Address - Phone:734-528-5700
Mailing Address - Fax:734-528-5701
Practice Address - Street 1:3145 W CLARK RD
Practice Address - Street 2:STE 401
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1120
Practice Address - Country:US
Practice Address - Phone:734-528-5700
Practice Address - Fax:734-528-5701
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301024290207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B46171Medicare UPIN
N70790023Medicare PIN
0810357Medicare ID - Type Unspecified