Healthcare Provider Details

I. General information

NPI: 1083682876
Provider Name (Legal Business Name): CHERYL L BAILEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 S VANBUREN ST SUITE 101
GREEN BAY WI
54301-3504
US

IV. Provider business mailing address

910 E 26TH ST STE 200
MINNEAPOLIS MN
55404-4526
US

V. Phone/Fax

Practice location:
  • Phone: 920-433-3420
  • Fax: 920-338-6859
Mailing address:
  • Phone: 612-884-6300
  • Fax: 612-884-6363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number38956
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number38956
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number71627-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: