Provider Demographics
NPI:1467483925
Name:BAGOS, MAURA LYNN (DO)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:LYNN
Last Name:BAGOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:671 E BIG BEAVER RD
Mailing Address - Street 2:STE 111
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1421
Mailing Address - Country:US
Mailing Address - Phone:248-244-8545
Mailing Address - Fax:248-244-8582
Practice Address - Street 1:2701 TROY CENTER DR
Practice Address - Street 2:SUITE 260
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4753
Practice Address - Country:US
Practice Address - Phone:248-244-8545
Practice Address - Fax:248-244-8582
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2020-03-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIMB011649207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383368662OtherCOMMERCIAL
MI1156303474OtherBCBSM
MI4130308Medicaid
MI4130308Medicaid