Provider Demographics
NPI:1093026262
Name:MOORE-BALDWIN, DONYELLE (MD)
Entity Type:Individual
Prefix:MRS
First Name:DONYELLE
Middle Name:
Last Name:MOORE-BALDWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 W OUTER DR STE 205
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2626
Mailing Address - Country:US
Mailing Address - Phone:313-966-9521
Mailing Address - Fax:313-966-9091
Practice Address - Street 1:18 MARKET ST STE C
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-7403
Practice Address - Country:US
Practice Address - Phone:586-783-2222
Practice Address - Fax:583-783-6380
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301096977207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
09191977OtherDOB