Provider Demographics
NPI:1417184565
Name:BAILEY, CHRISTOPHER A (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:A
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 1:5437 LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1849
Mailing Address - Country:US
Mailing Address - Phone:708-655-7459
Mailing Address - Fax:
Practice Address - Street 1:33 W ONTARIO ST
Practice Address - Street 2:#35G
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-7760
Practice Address - Country:US
Practice Address - Phone:708-655-7459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274050207Q00000X
PAMD451169207Q00000X
MN59857207Q00000X
WAMD60443124207Q00000X
AZ48908207Q00000X
NMMD2014-0649207Q00000X
HIMD-17762207Q00000X
IAMD-42021207Q00000X
NV15501207Q00000X
WI62999-20207Q00000X
CODR.0054560207Q00000X
CAA131309207Q00000X
TXQ5343207Q00000X
NJ25MA09483100207Q00000X
IL036128437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine