Provider Demographics
NPI:1194962134
Name:PHILIP BAGENSKI, M.D.,P.A.
Entity type:Organization
Organization Name:PHILIP BAGENSKI, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:BAGENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-441-8133
Mailing Address - Street 1:1012 DRUID RD E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5606
Mailing Address - Country:US
Mailing Address - Phone:727-441-8133
Mailing Address - Fax:727-441-8224
Practice Address - Street 1:1012 DRUID RD E
Practice Address - Street 2:SUITE 100
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5606
Practice Address - Country:US
Practice Address - Phone:727-441-8133
Practice Address - Fax:727-441-8224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77670207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBZ812AMedicare PIN