Basic Information
Provider Information
NPI: 1003013814
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAILEY
FirstName: NATHANAEL
MiddleName: GLEN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3621 S STATE ST
Address2: 700 KMS PLACE
City: ANN ARBOR
State: MI
PostalCode: 48109
CountryCode: US
TelephoneNumber: 7349362047
FaxNumber:  
Practice Location
Address1: 1500 E MEDICAL CENTER DR
Address2: 2ND FLOOR UNIVERSITY HOSPITAL RECP PATHOLOGY
City: ANN ARBOR
State: MI
PostalCode: 481095054
CountryCode: US
TelephoneNumber: 8008627284
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/27/2007
LastUpdateDate: 04/05/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZH0000X4301095848MIN Allopathic & Osteopathic PhysiciansPathologyHematology
207ZH0000X22448WVN Allopathic & Osteopathic PhysiciansPathologyHematology
207ZP0007X4301095848MIN Allopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
207ZP0102X4301095848MIY Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
208D00000X22448WVN Allopathic & Osteopathic PhysiciansGeneral Practice 

No ID Information.


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