| NPI | 1508808049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL J BALDECK Owner/Physician 208-798-4814 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 0-185) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2020-08-22 |