Provider Demographics
NPI:1295779718
Name:BALDWIN, ELIZABETH (DPM)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3910
Mailing Address - Country:US
Mailing Address - Phone:847-398-0900
Mailing Address - Fax:847-398-0873
Practice Address - Street 1:1804 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3910
Practice Address - Country:US
Practice Address - Phone:847-398-0900
Practice Address - Fax:847-398-0873
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL73686Medicare PIN
ILU40649Medicare UPIN