Provider Demographics
NPI:1972698645
Name:BAILEY, KATHERINE (DPM)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 W WASHINGTON
Mailing Address - Street 2:STE 100
Mailing Address - City:OREGON
Mailing Address - State:IL
Mailing Address - Zip Code:61061-1022
Mailing Address - Country:US
Mailing Address - Phone:815-732-2581
Mailing Address - Fax:815-732-3926
Practice Address - Street 1:1307 W WASHINGTON
Practice Address - Street 2:STE 100
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061-1022
Practice Address - Country:US
Practice Address - Phone:815-732-2581
Practice Address - Fax:815-732-3926
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003426213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
480034798OtherRR MEDICARE
0060101255OtherBCBS
480034798OtherRR MEDICARE
T37852Medicare UPIN
IL687590Medicare ID - Type Unspecified