Healthcare Provider Details

I. General information

NPI: 1386715886
Provider Name (Legal Business Name): ALAN DREW BALDRIDGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 03/11/2023
Certification Date: 03/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2726 S SPURWAY DR
ANN ARBOR MI
48105-2293
US

IV. Provider business mailing address

2450 RIVERSIDE AVE EAST BUILDING, 6TH FLOOR
MINNEAPOLIS MN
55454-1450
US

V. Phone/Fax

Practice location:
  • Phone: 734-773-3105
  • Fax:
Mailing address:
  • Phone: 612-624-1133
  • Fax: 612-626-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number4301504837
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: