MEDICARE: DR. PHILIP F BAGENSKI 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	207R00000X	Internal Medicine Physician	ME77670	FL
2	207RA0401X	Addiction Medicine (Internal Medicine) Physician	ME77670	FL

General Provider Information

NPI Number	:	1811984818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP F BAGENSKI M.D.

Provider Business Mailing Address
First Line	:	3820 TAMPA RD
Second Line	:	SUITE 202
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3609
Country	:	US
Telephone Number	:	727-785-4540
Fax Number	:

Provider Business Practice Location Address
First Line	:	3820 TAMPA RD
Second Line	:	SUITE 202
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3609
Country	:	US
Telephone Number	:	727-785-4540
Fax Number	:

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	01/07/2016

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