Provider Demographics
NPI:1073595385
Name:BAGGA, SUDHIR K (MD)
Entity Type:Individual
Prefix:
First Name:SUDHIR
Middle Name:K
Last Name:BAGGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2839 HIGHWAY 231 N
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-7447
Mailing Address - Country:US
Mailing Address - Phone:931-685-8020
Mailing Address - Fax:931-685-8046
Practice Address - Street 1:2839 HIGHWAY 231 N
Practice Address - Street 2:SUITE 105
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-7447
Practice Address - Country:US
Practice Address - Phone:931-685-8020
Practice Address - Fax:931-685-8046
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD38741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4109044OtherBCBS
A27415Medicare UPIN
TN3329838Medicare ID - Type Unspecified