Individual
MR. MICHAEL RUSSELL BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
11704 W CENTER RD, STE 200, OMAHA, NE 68144-4375
(402) 691-0500
(402) 505-6249
Mailing address
11704 W CENTER RD, STE 200, OMAHA, NE 68144-4375
(402) 691-0500
(402) 505-6249
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
196
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
196
NE PA LICENSE NMBR
NE
01
—
R80756
IA BCBS PROVIDER NMBR
IA
Enumeration date
02/21/2006
Last updated
02/04/2021
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