Provider Demographics
NPI:1083616759
Name:BAILEY, ANDREW D (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:D
Last Name:BAILEY
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:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-253-1035
Mailing Address - Fax:502-253-1037
Practice Address - Street 1:4001 KRESGE WAY
Practice Address - Street 2:SUITE 130
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4640
Practice Address - Country:US
Practice Address - Phone:502-896-8447
Practice Address - Fax:502-896-8699
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2014-08-21
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
KY20497207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000049386OtherBCBS
IN100019910AMedicaid
KY64204977Medicaid
KY1058803OtherPASSPORT
KY2434025000OtherPASSPORT ADVANTAGE
KY2434025000OtherPASSPORT ADVANTAGE
KY64204977Medicaid
KY110033012Medicare Oscar/Certification