Healthcare Provider Details

I. General information

NPI: 1972559771
Provider Name (Legal Business Name): LYNN LOUISE BALDWIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E SUMMIT AVE
WALES WI
53183-9664
US

IV. Provider business mailing address

577 W RED PINE CIR
DOUSMAN WI
53118-8819
US

V. Phone/Fax

Practice location:
  • Phone: 262-968-5933
  • Fax: 262-968-5933
Mailing address:
  • Phone: 262-432-0233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31264
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: