Provider Demographics
NPI:1508827130
Name:BALDWIN, GAIL ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:ELAINE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:SOUTH RANGE
Mailing Address - State:WI
Mailing Address - Zip Code:54874-0038
Mailing Address - Country:US
Mailing Address - Phone:218-624-6584
Mailing Address - Fax:715-392-1901
Practice Address - Street 1:4325 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2730
Practice Address - Country:US
Practice Address - Phone:218-624-6584
Practice Address - Fax:715-392-1935
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33475207Q00000X
WI40624 020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40624 020OtherLICENSE
MN756202100Medicaid
WI31850400Medicaid
MN33475OtherLICENSE
WI40624 020OtherLICENSE