Provider Demographics
NPI:1235126954
Name:BAILEY, DAVID A (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2603 ELECTRIC AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6588
Mailing Address - Country:US
Mailing Address - Phone:810-329-3333
Mailing Address - Fax:810-329-1199
Practice Address - Street 1:2603 ELECTRIC AVE STE 2
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6588
Practice Address - Country:US
Practice Address - Phone:810-329-3333
Practice Address - Fax:810-329-1199
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101015538207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1235126954OtherNPI
MI4509567Medicaid
MI4509567Medicaid