Healthcare Provider Details

I. General information

NPI: 1417698838
Provider Name (Legal Business Name): BAILEY HEINZEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N MAIN ST
ARCANUM OH
45304-1421
US

IV. Provider business mailing address

5735 MEEKER RD
GREENVILLE OH
45331-1186
US

V. Phone/Fax

Practice location:
  • Phone: 937-692-6601
  • Fax:
Mailing address:
  • Phone: 937-548-9680
  • Fax: 937-548-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.018045
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: