Basic Information
| Provider Information | |||||||||
| NPI: | 1508827130 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALDWIN | ||||||||
| FirstName: | GAIL | ||||||||
| MiddleName: | ELAINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 38 | ||||||||
| Address2: | |||||||||
| City: | SOUTH RANGE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548740038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186246584 | ||||||||
| FaxNumber: | 7153921901 | ||||||||
| Practice Location | |||||||||
| Address1: | 4325 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558072730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186246584 | ||||||||
| FaxNumber: | 7153921935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 12/05/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 33475 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 40624 020 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 40624 020 | 01 | WI | LICENSE | OTHER | 756202100 | 05 | MN | MEDICAID | 31850400 | 05 | WI | MEDICAID | 33475 | 01 | MN | LICENSE | OTHER |