Provider Demographics
NPI:1124459318
Name:BALDWIN FAMILY HEALTH CARE
Entity type:Organization
Organization Name:BALDWIN FAMILY HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:231-745-5009
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:231-745-5024
Mailing Address - Fax:231-745-5026
Practice Address - Street 1:1615 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:MI
Practice Address - Zip Code:49304-7984
Practice Address - Country:US
Practice Address - Phone:231-745-5024
Practice Address - Fax:231-745-5026
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BALDWIN FAMILY HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-12
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5301010258OtherMICHIGAN STATE PHARMACY LICENSE