Healthcare Provider Details

I. General information

NPI: 1659682573
Provider Name (Legal Business Name): LOUIS D BAILEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 3RD ST S
GLASGOW MT
59230-2604
US

IV. Provider business mailing address

20234 DOVES POINTE DR
BROWNSTOWN MI
48174-8503
US

V. Phone/Fax

Practice location:
  • Phone: 406-228-3645
  • Fax: 406-228-3533
Mailing address:
  • Phone: 816-519-6502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number510101883
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: