Individual
INNOKENTIY BAKAEV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
150 PARK ST, LAWRENCE, MA 01841-2517
(978) 685-1770
(978) 682-5787
Mailing address
150 PARK ST, LAWRENCE, MA 01841-2517
(978) 685-1770
(978) 682-5787
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
254840
MA
390200000X
Student in an Organized Health Care Education/Training Program
2395431
MI
Other
Enumeration date
07/15/2009
Last updated
03/11/2014
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