Individual
THOMAS BAKER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6071 W OUTER DR, DETROIT, MI 48235-2624
(952) 442-9770
Mailing address
PO BOX 67000, DEPT 203401, DETROIT, MI 48267-0002
(952) 442-9770
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704147166
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TB147166
BLUE CROSS OF MI
MI
Enumeration date
02/24/2006
Last updated
07/08/2007
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