Individual
KELLY BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
9000 W WISCONSIN AVE, MILWAUKEE, WI 53226-4874
(414) 266-6457
(414) 266-2294
Mailing address
9000 W WISCONSIN AVE, MILWAUKEE, WI 53226-4874
(414) 266-6457
(414) 266-2294
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3828
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043663818
—
WI
Enumeration date
07/18/2016
Last updated
01/15/2021
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