Basic Information
| Provider Information | |||||||||
| NPI: | 1083682876 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 910 E 26TH ST | ||||||||
| Address2: | STE 200 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554044526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128846300 | ||||||||
| FaxNumber: | 6128846363 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 S VANBUREN ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543013504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204333420 | ||||||||
| FaxNumber: | 9203386859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 08/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 38956 | MN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207VX0201X | 38956 | MN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | 207V00000X | 71627-20 | WI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 16A76BA | 01 | MN | BCBS MN | OTHER | 497319400 | 05 | MN | MEDICAID | 32217400 | 05 | WI | MEDICAID | 26356 | 01 | MN | AMERICA'S PPO NUMBER | OTHER | HP19336 | 01 | MN | HEALTHPARTNERS | OTHER | 404933100 | 05 | MD | MEDICAID | 115880 | 01 | MN | UCARE MN | OTHER | 0703779 | 01 | MN | MEDICA | OTHER | 1011264 | 01 | MN | PREFERRED ONE | OTHER |