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General NPI Number Information
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NPI Number | 1508808049
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Entity Type | Organization
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Legal Business Name | MICHAEL J BALDECK, DO, PLLC
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 307 SAINT JOHNS WAY SUITE 4
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City | LEWISTON
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State | ID
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Zip | 83501-2435
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Country | US
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Telephone | 208-798-4818
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Fax | 208-798-8711
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Provider Business Mailing Address
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Address Line | 307 SAINT JOHNS WAY SUITE 4
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City | LEWISTON
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State | ID
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Zip | 83501-2435
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Country | US
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Telephone | 208-798-4818
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Fax | 208-798-8711
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. MICHAEL J BALDECK
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Credential | DO
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Telephone | 208-798-4814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0-185
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License Number State | ID
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