Provider Demographics
NPI:1063416956
Name:BAILEY, DAN STEVEN (DPM)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:STEVEN
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 S STANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-2307
Mailing Address - Country:US
Mailing Address - Phone:937-339-4330
Mailing Address - Fax:937-335-5234
Practice Address - Street 1:47 S STANFIELD RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2307
Practice Address - Country:US
Practice Address - Phone:937-339-4330
Practice Address - Fax:937-335-5234
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36 002126213EP1101X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311071464-00OtherWORKERS COMP ID
OH000000011257OtherANTHEM ID
OH0514152Medicaid
OH0541870001Medicare NSC
OHT80552Medicare UPIN
OH311071464-00OtherWORKERS COMP ID