Healthcare Provider Details

I. General information

NPI: 1104891696
Provider Name (Legal Business Name): BALDWIN FAMILY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 E WILCOX AVE
WHITE CLOUD MI
49349-8794
US

IV. Provider business mailing address

1035 E WILCOX AVE P.O. BOX 706
WHITE CLOUD MI
49349-8794
US

V. Phone/Fax

Practice location:
  • Phone: 231-689-6677
  • Fax: 231-689-3869
Mailing address:
  • Phone: 231-689-6677
  • Fax: 231-689-3869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301007624
License Number StateMI

VIII. Authorized Official

Name: MS. JULIE TATKO
Title or Position: PRESIDENT/CEO
Credential:
Phone: 231-745-5009