MEDICARE: DR. MICHAEL JUSTIN BAILEY M.D.

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	2084P0800X	Psychiatry Physician	G56334	CA

General Provider Information

NPI Number	:	1891885653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JUSTIN BAILEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 19989
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92159-0989
Country	:	US
Telephone Number	:	619-641-6311
Fax Number	:	619-641-6322

Provider Business Practice Location Address
First Line	:	3111 CAMINO DEL RIO N
Second Line	:	SUITE 600
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-5720
Country	:	US
Telephone Number	:	619-641-6311
Fax Number	:	619-641-6322

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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