Provider Demographics
NPI:1083682876
Name:BAILEY, CHERYL L (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:910 E 26TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4526
Mailing Address - Country:US
Mailing Address - Phone:612-884-6300
Mailing Address - Fax:612-884-6363
Practice Address - Street 1:720 S VANBUREN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3504
Practice Address - Country:US
Practice Address - Phone:920-433-3420
Practice Address - Fax:920-338-6859
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN38956207VG0400X, 207VX0201X
WI71627-20207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN16A76BAOtherBCBS MN
MN497319400Medicaid
WI32217400Medicaid
MN26356OtherAMERICA'S PPO NUMBER
MNHP19336OtherHEALTHPARTNERS
MD404933100Medicaid
MN115880OtherUCARE MN
MN0703779OtherMEDICA
MN1011264OtherPREFERRED ONE
MN115880OtherUCARE MN
MN497319400Medicaid
WI32217400Medicaid