Provider Demographics
NPI:1346211653
Name:BAGLEY, MICHELE L (DO)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7847
Mailing Address - Country:US
Mailing Address - Phone:606-325-9644
Mailing Address - Fax:606-329-1207
Practice Address - Street 1:2222 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7847
Practice Address - Country:US
Practice Address - Phone:606-325-9644
Practice Address - Fax:606-329-1207
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02284207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000045746OtherBLUE CROSS AND BLUE SHIELD
000000583693OtherBLUE CROSS AND BLUE SHIELD
KY1208004Medicare PIN
000000045746OtherBLUE CROSS AND BLUE SHIELD