MEDICARE: DR. VALERIE ANNE BAGWAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	OS7804	FL

General Provider Information

NPI Number	:	1568490217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VALERIE ANNE BAGWAN D.O.

Provider Business Mailing Address
First Line	:	7369 SHERIDAN ST STE 102
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2776
Country	:	US
Telephone Number	:	954-981-3106
Fax Number	:

Provider Business Practice Location Address
First Line	:	7369 SHERIDAN ST STE 102
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2776
Country	:	US
Telephone Number	:	954-981-3106
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/08/2007

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