Individual
MR. JAVON I BAKER SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BEP CERTIFICATE
Contact information
Practice address
222 W FOREST AVE APT 306, ROUND LAKE, IL 60073-3541
(312) 914-7513
Mailing address
222 W FOREST AVE APT 306, ROUND LAKE, IL 60073-3541
(312) 914-7513
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
B260-4297-8034
IL
Other
Enumeration date
01/13/2022
Last updated
01/13/2022
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