Provider Demographics
NPI:1306837083
Name:BAYLIS, LEE D (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:D
Last Name:BAYLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5825 S MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2983
Mailing Address - Country:US
Mailing Address - Phone:248-625-7717
Mailing Address - Fax:248-625-5849
Practice Address - Street 1:5825 S MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2983
Practice Address - Country:US
Practice Address - Phone:248-625-7717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061396207RA0201X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G76712Medicare UPIN
0M81020Medicare ID - Type Unspecified