MEDICARE: KEITH DALE BAILEY MD

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
1	207RH0003X	Hematology & Oncology Physician	4301041932	MI
2	207RX0202X	Medical Oncology Physician	4301041932	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110102734	OTHER	MI	MEDICARE ID TYPE UNSPECIF

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	11-0390150-1	OTHER	MI	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1447261730	OTHER	MI	BCBSM - WMCC
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538136718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH DALE BAILEY MD

Provider Business Mailing Address
First Line	:	200 N PARK ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-3731
Country	:	US
Telephone Number	:	269-373-7488
Fax Number	:	269-373-0123

Provider Business Practice Location Address
First Line	:	200 N PARK ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-3731
Country	:	US
Telephone Number	:	269-373-7488
Fax Number	:	269-373-0123

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	10/30/2014

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Directions to “ KEITH DALE BAILEY MD” Practice Location

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