Provider Demographics
NPI:1992127930
Name:MICHAEL B. BAYLESS & ASSOCIATES, LLC
Entity type:Organization
Organization Name:MICHAEL B. BAYLESS & ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYLESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-230-7373
Mailing Address - Street 1:2701 E CAMELBACK RD
Mailing Address - Street 2:STE. 155
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4309
Mailing Address - Country:US
Mailing Address - Phone:602-230-7373
Mailing Address - Fax:
Practice Address - Street 1:5505 W CHANDLER BLVD
Practice Address - Street 2:STE. 11
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3683
Practice Address - Country:US
Practice Address - Phone:602-230-7373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC5768261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty