Most Relevant Information
Provider Data
| NPI Number: | 1003561309 |
| Provider Name: | JEROMY LEE BALDUF PA-C, RDN |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/15/2022 |
| Last Updated: | 02/15/2022 |
Provider Practice Location
6400 LEORA LN
OTTAWA LAKE
MI
492679627
Practice Location Phone/Fax
| Phone: | 4193566458 |
| Fax: |
Provider Mailing Location
6400 LEORA LN
OTTAWA LAKE
MI
492679627
Provider Mailing Phone/Fax
| Phone: | 4193566458 |
| Fax: |