MEDICARE: BAILEY E TAYEBI M.D., M.B.A.

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	207N00000X	Dermatology Physician	01077179A	IN
2	207ND0101X	MOHS-Micrographic Surgery Physician	01077179A	IN

General Provider Information

NPI Number	:	1528359668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY E TAYEBI M.D., M.B.A.

Provider Business Mailing Address
First Line	:	801 YORK ST
Second Line	:
City	:	MANITOWOC
State	:	WI
Zip	:	54220-4630
Country	:	US
Telephone Number	:	920-663-9008
Fax Number	:	920-684-1439

Provider Business Practice Location Address
First Line	:	755 W CARMEL DR STE 101
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-5875
Country	:	US
Telephone Number	:	317-846-2396
Fax Number	:	317-846-1699

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

Provider Enumeration Date	:	04/25/2011
Last Update Date	:	09/29/2025

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