Healthcare Provider Details

I. General information

NPI: 1659085140
Provider Name (Legal Business Name): RICHARD B BAILEY RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NORTH 92ND STREET MILWAUKEE
MILWAUKEE WI
53226-5322
US

IV. Provider business mailing address

3425 S 16TH ST
MILWAUKEE WI
53215-4903
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-3000
  • Fax:
Mailing address:
  • Phone: 414-595-8634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number5583
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: