Provider Demographics
NPI:1780615666
Name:BAILEY, DOUGLAS F (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:F
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3400 W 66TH ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2111
Mailing Address - Country:US
Mailing Address - Phone:952-832-0805
Mailing Address - Fax:952-832-5597
Practice Address - Street 1:303 E NICOLLET BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4522
Practice Address - Country:US
Practice Address - Phone:952-435-4140
Practice Address - Fax:952-435-4189
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN37590208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN168217200Medicaid
MNG39343Medicare UPIN
MN168217200Medicaid