MEDICARE: MICHELLE LYNN BAGLIO

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	133V00000X	Registered Dietitian	DT80170	TX

General Provider Information

NPI Number	:	1326180522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LYNN BAGLIO

Provider Business Mailing Address
First Line	:	1202 E SONTERRA BLVD
Second Line	:	STE 601
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4089
Country	:	US
Telephone Number	:	210-499-6500
Fax Number	:	210-499-6572

Provider Business Practice Location Address
First Line	:	1202 E SONTERRA BLVD
Second Line	:	STE 601
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4089
Country	:	US
Telephone Number	:	210-499-6500
Fax Number	:	210-499-6572

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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