Healthcare Provider Details

I. General information

NPI: 1366444283
Provider Name (Legal Business Name): SUSAN K. BAILEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN B. WHITE D.O.

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 03/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29017 CEDAR RD UH LYNDHUST SURGERY CENTER
LYNDHURST OH
44124-4073
US

IV. Provider business mailing address

24701 EUCLID AVE THIRD FLOOR BILLING SERVICES
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 440-460-8000
  • Fax: 440-460-1759
Mailing address:
  • Phone: 440-460-8000
  • Fax: 440-460-6321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34005539
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: