Individual
MICHELLE M BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
13170 RAVENNA ROAD, SUITE 200, CHARDON, OH 44024
(844) 542-6363
(440) 279-1582
Mailing address
13170 RAVENNA RD #200, SUITE 200, CHARDON, OH 44024-4426
(844) 542-6363
(440) 279-1582
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
50.004977RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0211306
—
OH
01
—
H507850
MEDICARE
OH
01
—
H507851
MEDICARE
OH
Enumeration date
03/06/2017
Last updated
03/01/2021
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