Provider Demographics
NPI:1053378976
Name:BAILEY, TIMOTHY S (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:S
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2300 N EDWARD ST
Mailing Address - Street 2:GSBLL
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4163
Mailing Address - Country:US
Mailing Address - Phone:217-877-5421
Mailing Address - Fax:217-877-0234
Practice Address - Street 1:1 MEMORIAL DR STE 300
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6322
Practice Address - Country:US
Practice Address - Phone:217-876-5500
Practice Address - Fax:217-876-5505
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081501208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081501Medicaid
ILF52030Medicare UPIN
IL036081501Medicaid