Individual
KEITH DALE BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 N PARK ST, KALAMAZOO, MI 49007-3731
(269) 373-7488
(269) 373-0123
Mailing address
200 N PARK ST, KALAMAZOO, MI 49007-3731
(269) 373-7488
(269) 373-0123
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
4301041932
MI
207RX0202X
Medical Oncology Physician
4301041932
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11-0390150-1
BCBS
MI
01
—
110102734
MEDICARE ID TYPE UNSPECIF
MI
05
—
1338976
—
MI
01
—
1447261730
BCBSM - WMCC
MI
05
—
1538136718
—
MI
Enumeration date
03/07/2006
Last updated
10/30/2014
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