Provider Demographics
NPI:1659084119
Name:POGLIANO, BAILEY ELISABETH (PA)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:ELISABETH
Last Name:POGLIANO
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:
Practice Address - Street 1:221 MICHIGAN ST NE STE 400
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2538
Practice Address - Country:US
Practice Address - Phone:616-486-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2023-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601011597363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant