Healthcare Provider Details

I. General information

NPI: 1770577033
Provider Name (Legal Business Name): JOHN JAMES BAGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 SKYLINE BLVD
CLOQUET MN
55720-3787
US

IV. Provider business mailing address

3531 E 1ST ST
DULUTH MN
55804-1806
US

V. Phone/Fax

Practice location:
  • Phone: 218-879-4641
  • Fax: 218-879-9167
Mailing address:
  • Phone: 218-724-2019
  • Fax: 218-786-0226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number39541
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: