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NPI Code Detail

MEDICARE: MICHELE L BAGLEY D.O.

MEDICARE: MICHELE L BAGLEY D.O.
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 Physician02284KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000045746OTHERBLUE CROSS AND BLUE SHIELD
2000000583693OTHERBLUE CROSS AND BLUE SHIELD

General Provider Information

NPI Number : 1346211653
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELE L BAGLEY D.O.
Provider Business Mailing Address
First Line : 2222 WINCHESTER AVE
Second Line :
City : ASHLAND
State : KY
Zip : 41101-7847
Country : US
Telephone Number : 606-325-9644
Fax Number : 606-329-1207
Provider Business Practice Location Address
First Line : 2222 WINCHESTER AVE
Second Line :
City : ASHLAND
State : KY
Zip : 41101-7847
Country : US
Telephone Number : 606-325-9644
Fax Number : 606-329-1207
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2006
Last Update Date : 08/20/2009

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Directions to “ MICHELE L BAGLEY D.O.” Practice Location

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