Provider Demographics
NPI:1720383169
Name:BAYLESS, MICHAEL LAMPTON
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LAMPTON
Last Name:BAYLESS
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 1:4709 NW 46TH DR
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73122-5308
Mailing Address - Country:US
Mailing Address - Phone:405-808-5058
Mailing Address - Fax:
Practice Address - Street 1:4709 NW 46TH DR
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73122-5308
Practice Address - Country:US
Practice Address - Phone:405-808-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-16
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator