Individual
MOLLY BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1700 LUTHER LN STE 1170, PARK RIDGE, IL 60068-1270
(844) 376-3876
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-006896
IL
363AS0400X
Surgical Physician Assistant
085-006896
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1139746
NCCPA
IL
Enumeration date
12/18/2018
Last updated
02/12/2025
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