1881675163 NPI number — FRANK BAGNASCO MD PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881675163 NPI number — FRANK BAGNASCO MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRANK BAGNASCO MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881675163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2009
NPI Reactivation Date:
03/09/2011

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44555 WOODWARD AVENUE
Provider Second Line Business Mailing Address:
SUITE 507
Provider Business Mailing Address City Name:
PONTIAC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48341-2935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-335-8170
Provider Business Mailing Address Fax Number:
248-858-3920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44555 WOODWARD AVENUE
Provider Second Line Business Practice Location Address:
SUITE 507
Provider Business Practice Location Address City Name:
PONTIAC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48341-2935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-335-8170
Provider Business Practice Location Address Fax Number:
248-858-3920
Provider Enumeration Date:
11/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BAGNASCO
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-335-8170

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  FB034436 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104150113 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: FB034436 . This is a "LICENSE STATE OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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