Provider Demographics
NPI:1366444283
Name:BAILEY, SUSAN K (DO)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:K
Last Name:BAILEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:B
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-460-8000
Mailing Address - Fax:440-460-6321
Practice Address - Street 1:29017 CEDAR RD
Practice Address - Street 2:UH LYNDHUST SURGERY CENTER
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-4073
Practice Address - Country:US
Practice Address - Phone:440-460-8000
Practice Address - Fax:440-460-1759
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005539207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0144516Medicaid
OHWH0784695Medicare ID - Type Unspecified
OH0144516Medicaid