MEDICARE: BAY MEDICAL GROUP, INC

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	207Q00000X	Family Medicine Physician	OS9465	FL

General Provider Information

NPI Number	:	1407222441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	931 SW 122ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33184-2477
Country	:	US
Telephone Number	:	305-223-0570
Fax Number	:	305-223-0580

Provider Business Practice Location Address
First Line	:	931 SW 122ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33184-2477
Country	:	US
Telephone Number	:	305-223-0570
Fax Number	:	305-223-0580

Authorized Official
Title or Position	:	OWNER/MEDICAL DIRECTOR
Name	:	DR. TREVOR BAILEY
Credential	:	D.O.
Telephone Number	:	305-223-0570

Provider Enumeration Date	:	08/13/2015
Last Update Date	:	05/12/2017

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