Individual
JEROMY LEE BALDUF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C, RDN
Contact information
Practice address
6400 LEORA LN, OTTAWA LAKE, MI 49267-9627
(419) 356-6458
Mailing address
6400 LEORA LN, OTTAWA LAKE, MI 49267-9627
(419) 356-6458
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
02/15/2022
Last updated
02/15/2022
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