Provider Demographics
NPI:1003561309
Name:BALDUF, JEROMY LEE (PA-C, RDN)
Entity type:Individual
Prefix:
First Name:JEROMY
Middle Name:LEE
Last Name:BALDUF
Suffix:
Gender:M
Credentials:PA-C, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 LEORA LN
Mailing Address - Street 2:
Mailing Address - City:OTTAWA LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49267-9627
Mailing Address - Country:US
Mailing Address - Phone:419-356-6458
Mailing Address - Fax:
Practice Address - Street 1:6400 LEORA LN
Practice Address - Street 2:
Practice Address - City:OTTAWA LAKE
Practice Address - State:MI
Practice Address - Zip Code:49267-9627
Practice Address - Country:US
Practice Address - Phone:419-356-6458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant