MEDICARE: DR. KATHY L BAGLAN M.D.

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	2085R0001X	Radiation Oncology Physician	2001031798	MO
2	2085R0001X	Radiation Oncology Physician	036142185	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538122163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHY L BAGLAN M.D.

Provider Business Mailing Address
First Line	:	11475 OLDE CABIN RD
Second Line	:	SUITE 200
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-7128
Country	:	US
Telephone Number	:	314-991-8200
Fax Number	:	314-991-8206

Provider Business Practice Location Address
First Line	:	607 S NEW BALLAS RD
Second Line	:	SUITE T-1275
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8222
Country	:	US
Telephone Number	:	314-251-6844
Fax Number	:	314-251-4337

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	04/12/2017

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