Provider Demographics
NPI:1508845603
Name:BAILA, HOREA (MD)
Entity Type:Individual
Prefix:
First Name:HOREA
Middle Name:
Last Name:BAILA
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:PO BOX 166324
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116-6324
Mailing Address - Country:US
Mailing Address - Phone:239-624-3570
Mailing Address - Fax:239-624-3571
Practice Address - Street 1:221 NE GLEN OAK AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-4307
Practice Address - Country:US
Practice Address - Phone:309-672-5790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36105403207ZP0101X
FLME148914207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361054032Medicaid
ILP00359538OtherRAILROAD MEDICARE
ILK33354Medicare PIN
ILK33353Medicare PIN
I11011Medicare UPIN
IL0361054032Medicaid