Provider Demographics
NPI:1942059084
Name:BAYLIS, OLIVIA (DO)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:BAYLIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27450 SCHOENHERR RD STE 400
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6684
Mailing Address - Country:US
Mailing Address - Phone:586-576-4158
Mailing Address - Fax:586-582-7515
Practice Address - Street 1:27450 SCHOENHERR RD STE 400
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6684
Practice Address - Country:US
Practice Address - Phone:586-582-7550
Practice Address - Fax:586-582-7515
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151017014390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program