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Individual

MICHAEL ROY BALDWIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
315 EASTWOOD DR, PLYMOUTH, IN 46563-7950
(574) 361-5857
Mailing address
315 EASTWOOD DR, PLYMOUTH, IN 46563-7950
(574) 361-5857

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
168609 REGISTRY#4405
CO
367500000X
Certified Registered Nurse Anesthetist
209-001985
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
28077464A
IN
367500000X
Certified Registered Nurse Anesthetist
4704251112
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000519814
ANTHEM
IN
05
200373090
IN
Enumeration date
09/20/2006
Last updated
08/12/2013
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