Provider Demographics
NPI:1639239486
Name:BALDOMERO, MARIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:L
Last Name:BALDOMERO
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1300 SOUTH DR.
Mailing Address - Street 2:WINNEBAGO MENTAL HEALTH INSTITUTE
Mailing Address - City:WINNEBAGO
Mailing Address - State:WI
Mailing Address - Zip Code:54985-0009
Mailing Address - Country:US
Mailing Address - Phone:920-235-4910
Mailing Address - Fax:920-236-2931
Practice Address - Street 1:1300 SOUTH DR.
Practice Address - Street 2:WINNEBAGO MENTAL HEALTH INSTITUTE
Practice Address - City:WINNEBAGO
Practice Address - State:WI
Practice Address - Zip Code:54985-0009
Practice Address - Country:US
Practice Address - Phone:920-235-4910
Practice Address - Fax:920-236-2931
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
WI430512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34468800Medicaid
WI34468800Medicaid
WI34468800Medicaid