MEDICARE: DR. STEPHEN WAYNE DAILEY JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PS0010X	Sports Medicine (Emergency Medicine) Physician	35-06-0704	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	200025841	OTHER	OH	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000004437	OTHER	OH	ANTHEM
2	0900645	OTHER	OH	UNITED HEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1895362001	OTHER	OH	CIGNA

General Provider Information

NPI Number	:	1134128200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN WAYNE DAILEY JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 636256 CENTRAL CREDENTIALING
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-0001
Country	:	US
Telephone Number	:	513-585-5506
Fax Number	:	513-585-5511

Provider Business Practice Location Address
First Line	:	222 PIEDMONT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-4231
Country	:	US
Telephone Number	:	513-475-8690
Fax Number	:	513-475-7593

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	11/22/2017

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Directions to “ DR. STEPHEN WAYNE DAILEY JR. MD” Practice Location

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