Provider Demographics
NPI:1447346408
Name:BAILEY INGRAM, MICHELE LINDA LEE (MD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LINDA LEE
Last Name:BAILEY INGRAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:LINDA LEE
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:16 NORTH BROADWAY
Mailing Address - Street 2:SUITE LMG
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601
Mailing Address - Country:US
Mailing Address - Phone:914-686-1848
Mailing Address - Fax:914-397-0001
Practice Address - Street 1:16 N BROADWAY
Practice Address - Street 2:SUITE LMG MAYFIELD MEDICAL GROUP LLC
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601
Practice Address - Country:US
Practice Address - Phone:914-686-1848
Practice Address - Fax:914-397-0001
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196315208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01618253Medicaid
G20208Medicare UPIN