Provider Demographics
NPI:1538122163
Name:BAGLAN, KATHY L (MD)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:L
Last Name:BAGLAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:11475 OLDE CABIN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7128
Mailing Address - Country:US
Mailing Address - Phone:314-991-8200
Mailing Address - Fax:314-991-8206
Practice Address - Street 1:607 S NEW BALLAS RD
Practice Address - Street 2:SUITE T-1275
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8222
Practice Address - Country:US
Practice Address - Phone:314-251-6844
Practice Address - Fax:314-251-4337
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2017-04-12
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Provider Licenses
StateLicense IDTaxonomies
MO20010317982085R0001X
IL0361421852085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205802606Medicaid
MO205802606Medicaid
ILF400359943Medicare PIN
MO027010288Medicare PIN
MO107690013Medicare PIN