Basic Information
| Provider Information | |||||||||
| NPI: | 1992127930 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MICHAEL B. BAYLESS & ASSOCIATES, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BAYLESS HEALTHCARE GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 E CAMELBACK RD | ||||||||
| Address2: | STE. 155 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850164309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022307373 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5505 W CHANDLER BLVD | ||||||||
| Address2: | STE. 11 | ||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852263683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022307373 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2014 | ||||||||
| LastUpdateDate: | 11/13/2020 | ||||||||
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| AuthorizedOfficialLastName: | BAYLESS | ||||||||
| AuthorizedOfficialFirstName: | JUSTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6022307373 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | OTC5768 | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.