Provider Demographics
NPI:1881675163
Name:FRANK BAGNASCO MD PC
Entity Type:Organization
Organization Name:FRANK BAGNASCO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BAGNASCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-335-8170
Mailing Address - Street 1:44555 WOODWARD AVENUE
Mailing Address - Street 2:SUITE 507
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-2935
Mailing Address - Country:US
Mailing Address - Phone:248-335-8170
Mailing Address - Fax:248-858-3920
Practice Address - Street 1:44555 WOODWARD AVENUE
Practice Address - Street 2:SUITE 507
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-2935
Practice Address - Country:US
Practice Address - Phone:248-335-8170
Practice Address - Fax:248-858-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2023-03-07
Deactivation Date:2009-07-17
Deactivation Code:
Reactivation Date:2011-03-09
Provider Licenses
StateLicense IDTaxonomies
MIFB034436207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104150113Medicaid
MIFB034436OtherLICENSE STATE OF MICHIGAN
MIFB034436OtherLICENSE STATE OF MICHIGAN
B43643Medicare UPIN
OM84570Medicare ID - Type Unspecified