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NPI Code Detail

MEDICARE: DR. KRISTIN S BAGLEY M.D.

MEDICARE: DR. KRISTIN S BAGLEY M.D.
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
1207Q00000XFamily Medicine Physician01059143AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3000000332737OTHERINANTHEM PIN#
47278588OTHERINAETNA PIN#

General Provider Information

NPI Number : 1710971734
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTIN S BAGLEY M.D.
Provider Business Mailing Address
First Line : 156 W. MUSKEGON DRIVE
Second Line :
City : GREENFIELD
State : IN
Zip : 46140-3069
Country : US
Telephone Number : 317-468-6257
Fax Number : 317-468-6268
Provider Business Practice Location Address
First Line : 7375 W. US 52
Second Line : NEW PALESTINE FAMILY MEDICINE
City : NEW PALESTINE
State : IN
Zip : 46163-8950
Country : US
Telephone Number : 317-861-4171
Fax Number : 317-861-5325
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2005
Last Update Date : 08/06/2014

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