Provider Demographics
NPI:1003179300
Name:BAILEY, CHAD MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:MICHAEL
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 1:17930 TALBOT RD S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6230
Mailing Address - Country:US
Mailing Address - Phone:425-228-3187
Mailing Address - Fax:425-228-7972
Practice Address - Street 1:17930 TALBOT RD S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055
Practice Address - Country:US
Practice Address - Phone:425-228-3187
Practice Address - Fax:425-228-7972
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR63362086S0122X
WAMD60937352208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2136095Medicaid
TX387114702Medicaid
TX387114701Medicaid
TX8JM817OtherBCBS