Provider Demographics
NPI:1982054268
Name:BALDAUF, MICHAEL W (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:BALDAUF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3409 LUDINGTON STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829
Mailing Address - Country:US
Mailing Address - Phone:906-789-4427
Mailing Address - Fax:906-789-4446
Practice Address - Street 1:3409 LUDINGTON STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829
Practice Address - Country:US
Practice Address - Phone:906-789-4427
Practice Address - Fax:906-789-4446
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301502042207R00000X, 208000000X
IL125.069228207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1982054268Medicaid