Provider Demographics
NPI:1982815932
Name:BALDWIN FAMILY HEALTH CARE
Entity Type:Organization
Organization Name:BALDWIN FAMILY HEALTH CARE
Other - Org Name:GREAT LAKES FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TATKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-745-2743
Mailing Address - Street 1:1615 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:MI
Mailing Address - Zip Code:49304-7984
Mailing Address - Country:US
Mailing Address - Phone:231-745-2743
Mailing Address - Fax:
Practice Address - Street 1:520 COBB ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2588
Practice Address - Country:US
Practice Address - Phone:231-775-6521
Practice Address - Fax:231-876-6519
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BALDWIN FAMILY HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-24
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700D360000OtherBCN
0D36000OtherBCBS
MI700D360000OtherBCN
MI0D36000Medicare PIN
231921Medicare Oscar/Certification