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General NPI Number Information
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NPI Number | 1821343625
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Entity Type | Individual
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Provider Name | ALIYA BAYANAGARI MD
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Gender | Female
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 405 S MAIN ST
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City | RAEFORD
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State | NC
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Zip | 28376-3222
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Country | US
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Telephone | 910-615-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 W STOUT ST
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City | RICE LAKE
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State | WI
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Zip | 54868-5000
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Country | US
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Telephone | 715-236-8310
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Fax |
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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 | 64352-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2024-01360
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License Number State | NC
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