Individual
DEREK BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
15855 19 MILE RD, CLINTON TOWNSHIP, MI 48038-3504
(586) 263-2715
Mailing address
5767 SHANNON LN, CLARKSTON, MI 48348-5168
(248) 535-8644
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704293006
MI
Other
Enumeration date
12/08/2018
Last updated
12/08/2018
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