Provider Demographics
NPI:1952358202
Name:BAKER, STEPHEN L (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 N PARK DR
Mailing Address - Street 2:SUITE 30
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-2200
Mailing Address - Country:US
Mailing Address - Phone:812-314-0032
Mailing Address - Fax:
Practice Address - Street 1:2475 N PARK DR
Practice Address - Street 2:SUITE 30
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-2200
Practice Address - Country:US
Practice Address - Phone:812-314-0032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042283A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN056443POtherSIHO PROVIDER ID
IN000000193783OtherANTHEM PROVIDER ID
INF79408Medicare UPIN
IN182050DMedicare ID - Type Unspecified