Provider Demographics
NPI:1306356795
Name:BAILEY, CARLOS LAMONT
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:LAMONT
Last Name:BAILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3239 TANSEL RD UNIT 34035
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-4601
Mailing Address - Country:US
Mailing Address - Phone:317-362-6234
Mailing Address - Fax:317-377-4539
Practice Address - Street 1:3239 TANSEL RD UNIT 34035
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-4601
Practice Address - Country:US
Practice Address - Phone:317-362-6234
Practice Address - Fax:317-377-4539
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2330905299172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver