Healthcare Provider Details

I. General information

NPI: 1053378976
Provider Name (Legal Business Name): TIMOTHY S BAILEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEMORIAL DR STE 300
DECATUR IL
62526-6322
US

IV. Provider business mailing address

2300 N EDWARD ST GSBLL
DECATUR IL
62526-4163
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-5500
  • Fax: 217-876-5505
Mailing address:
  • Phone: 217-877-5421
  • Fax: 217-877-0234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036081501
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: