Healthcare Provider Details

I. General information

NPI: 1508961749
Provider Name (Legal Business Name): BALDWIN FAMILY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 MICHIGAN AVE
BALDWIN MI
49304-7984
US

IV. Provider business mailing address

1615 MICHIGAN AVE
BALDWIN MI
49304-7984
US

V. Phone/Fax

Practice location:
  • Phone: 231-745-2736
  • Fax: 231-745-5050
Mailing address:
  • Phone: 231-745-2736
  • Fax: 231-745-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MS. JULIE TATKO
Title or Position: CEO
Credential:
Phone: 231-745-2743