Healthcare Provider Details

I. General information

NPI: 1245201490
Provider Name (Legal Business Name): GARY W BAILEY D. O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 BURTON ST SE
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

2525 BURTON ST SE
GRAND RAPIDS MI
49546-4834
US

V. Phone/Fax

Practice location:
  • Phone: 616-957-2410
  • Fax: 616-957-2411
Mailing address:
  • Phone: 616-957-2410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101007477
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberGB007477
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: