Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 36055789 | IL |
NPI | 1598879223 |
---|---|
Provider Name | Michael D Baldinger |
First Address | Chicago, IL 60614-8160 |
Second Address | Chicago, IL 60614-8160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 13/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C42306 | (02) | IL |