Provider Demographics
NPI:1891773479
Name:BALDAUF, JOHN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:BALDAUF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 E. DESERT INN RD., STE100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3609
Mailing Address - Country:US
Mailing Address - Phone:702-731-1616
Mailing Address - Fax:702-734-4900
Practice Address - Street 1:2800 E DESERT INN RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3609
Practice Address - Country:US
Practice Address - Phone:702-731-1616
Practice Address - Fax:702-734-4900
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9461207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
7541165OtherAETNA
CC6656OtherBXBS
NV100503082Medicaid
P00146571OtherR.R. MEDICARE
P00146571OtherR.R. MEDICARE
39102Medicare ID - Type Unspecified