Michael J Baldeck, DO, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0-185 Issued in ID

Legal business name

MICHAEL J BALDECK, DO, PLLC

Practice address

307 Saint Johns Way
Suite 4
Lewiston, ID 83501-2435

Phone

(208) 798-4818

Fax

(208) 798-8711

NPI assigned

Jun 11, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael J Baldeck, DO

Title

Owner/Physician

Phone

(208) 798-4814

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508808049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 SAINT JOHNS WAY",
            "address_2": "SUITE 4",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012435",
            "telephone_number": "208-798-4818",
            "fax_number": "208-798-8711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 SAINT JOHNS WAY",
            "address_2": "SUITE 4",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012435",
            "telephone_number": "208-798-4818",
            "fax_number": "208-798-8711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J BALDECK, DO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BALDECK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "208-798-4814",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "0-185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.