Healthcare Provider Details

I. General information

NPI: 1528727344
Provider Name (Legal Business Name): MICHAEL BAILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 12/08/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

IV. Provider business mailing address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-6018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN350909
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: