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NPI Code Detail

MEDICARE: LILLY ANN BAYOUTH M.D.

MEDICARE: LILLY ANN BAYOUTH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12086S0127XTrauma Surgery PhysicianME163279FL
2208600000XSurgery Physician2021-01560NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053731133
Entity Type Code : Individual
Provider Name (Legal Business Name) : LILLY ANN BAYOUTH M.D.
Provider Business Mailing Address
First Line : PO BOX 2147
Second Line :
City : FORT MYERS
State : FL
Zip : 33902-2147
Country : US
Telephone Number : 239-343-1612
Fax Number : 239-343-4229
Provider Business Practice Location Address
First Line : 13685 DOCTORS WAY STE 100
Second Line :
City : FORT MYERS
State : FL
Zip : 33912-4337
Country : US
Telephone Number : 239-343-1612
Fax Number : 239-343-4229
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2014
Last Update Date : 09/08/2023

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Directions to “ LILLY ANN BAYOUTH M.D.” Practice Location

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