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General NPI Number Information
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NPI Number | 1710971734
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Entity Type | Individual
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Provider Name | KRISTIN S BAGLEY M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/06/2005
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 7375 W. US 52 NEW PALESTINE FAMILY MEDICINE
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City | NEW PALESTINE
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State | IN
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Zip | 46163-8950
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Country | US
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Telephone | 317-861-4171
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Fax | 317-861-5325
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Provider Business Mailing Address
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Address Line | 156 W. MUSKEGON DRIVE
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City | GREENFIELD
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State | IN
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Zip | 46140-3069
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Country | US
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Telephone | 317-468-6257
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Fax | 317-468-6268
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01059143A
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License Number State | IN
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