Provider Demographics
NPI:1760577357
Name:BAGNASCO, FRANK A (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:A
Last Name:BAGNASCO
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 1:44555 WOODWARD
Mailing Address - Street 2:SUITE 507
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341
Mailing Address - Country:US
Mailing Address - Phone:248-335-8170
Mailing Address - Fax:248-858-3920
Practice Address - Street 1:44555 WOODWARD
Practice Address - Street 2:SUITE 507
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341
Practice Address - Country:US
Practice Address - Phone:248-335-8170
Practice Address - Fax:248-858-3920
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301034436207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4150113Medicaid
MI4150113Medicaid
MIOM84570Medicare PIN