Provider Demographics
NPI:1427166651
Name:BAILUR, NAGESH D (MD)
Entity type:Individual
Prefix:
First Name:NAGESH
Middle Name:D
Last Name:BAILUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1849
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32756-1849
Mailing Address - Country:US
Mailing Address - Phone:352-360-8707
Mailing Address - Fax:
Practice Address - Street 1:1062 CEASARS CT
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6506
Practice Address - Country:US
Practice Address - Phone:352-360-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87433207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81704OtherBC BS
FL266934000Medicaid
FLU1082XMedicare PIN
FL81704OtherBC BS
FLP00103873Medicare PIN