Individual
BRYAN DANIEL BAILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5779 WOOSTER PIKE, MEDINA, OH 44256-8816
(330) 725-0569
(330) 662-0258
Mailing address
5783 WOOSTER PIKE, MEDINA, OH 44256-8816
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
35.132996
OH
207ND0101X
MOHS-Micrographic Surgery Physician
35.132996
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0329928
—
OH
Enumeration date
03/29/2014
Last updated
10/31/2020
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