Organization
BALDWIN FAMILY HEALTH CARE
Active
Parent organization
BALDWIN FAMILY HEALTH CARE
Other names
Great Lakes Family Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
BALDWIN FAMILY HEALTH CARE
Authorized official
MS. JULIE TATKO (CEO)
(231) 745-2743
Entity
Organization
Contact information
Practice address
520 COBB ST, CADILLAC, MI 49601-2588
(231) 775-6521
(231) 876-6519
Mailing address
1615 MICHIGAN AVE, BALDWIN, MI 49304-7984
(231) 745-2743
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0D36000
BCBS
—
01
—
700D360000
BCN
MI
Enumeration date
05/24/2007
Last updated
11/12/2020
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