Javon I Baker Sr., BEP CERTIFICATE
Individual provider Active NPI Driver · Round Lake, IL
NPI 1588315212 · NPPES record last updated Jan 13, 2022
Key facts
- NPI
- 1588315212
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- B260-4297-8034 (IL)
- Practice address
- 222 W Forest Ave Apt 306
Round Lake, IL 60073-3541 - Phone
- (312) 914-7513
- NPI assigned
- Jan 13, 2022
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B260-4297-8034 | IL | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | B260-4297-8034 | IL | Yes |
Addresses
Primary practice location
222 W Forest Ave Apt 306
Round Lake, IL 60073-3541
Mailing address
222 W Forest Ave Apt 306
Round Lake, IL 60073-3541
Phone (312) 914-7513
Other providers in Round Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.