Individual
LYDIA L. BALTAROWICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
HENRY FORD HEALTH SYSTEM, 2799 WEST GRAND BOULEVARD, DETROIT, MI 48202
(313) 916-2436
Mailing address
HENRY FORD HEALTH SYSTEM, 2799 WEST GRAND BOULEVARD, DETROIT, MI 48202
(313) 916-2436
Taxonomy
Speciality
Code
Description
License number
State
207PT0002X
Medical Toxicology (Emergency Medicine) Physician
Primary
4301041763
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010H262530
BLUE CROSS-BLUE CROSS
—
05
—
140460510
—
MI
01
—
LB041763
CHAMPUS-CHAMPUS
—
Enumeration date
11/17/2006
Last updated
07/08/2007
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