Healthcare Provider Details

I. General information

NPI: 1902308463
Provider Name (Legal Business Name): BALDWIN FAMILY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 WASHINGTON ST
BALDWIN MI
49304
US

IV. Provider business mailing address

1615 MICHIGAN AVE
BALDWIN MI
49304-7984
US

V. Phone/Fax

Practice location:
  • Phone: 231-745-4624
  • Fax: 231-745-5031
Mailing address:
  • Phone: 231-745-2743
  • Fax: 231-745-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JULIE TATKO
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 231-745-2743