Provider Demographics
NPI:1902847510
Name:BAYLIS, LARRY J (DO)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:J
Last Name:BAYLIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:7736 ORTONVILLE RD
Mailing Address - Street 2:STE. A
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-4483
Mailing Address - Country:US
Mailing Address - Phone:248-625-5885
Mailing Address - Fax:248-625-6794
Practice Address - Street 1:7736 ORTONVILLE RD
Practice Address - Street 2:STE. A
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4483
Practice Address - Country:US
Practice Address - Phone:248-625-5885
Practice Address - Fax:248-625-6794
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2012-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101010781207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080127004OtherMEDICARE RAILROAD
MI5630195OtherBCBS
MI080127004OtherMEDICARE RAILROAD
MIE92645Medicare UPIN