Individual
AGNES C BACALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12546 E US HIGHWAY 50, LOOGOOTEE, IN 47553-5220
(812) 295-5095
(812) 295-9403
Mailing address
PO BOX 760, WASHINGTON, IN 47501-0760
(812) 254-2760
(812) 254-8636
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01043434A
IN
207Q00000X
Family Medicine Physician
32413
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200072110
—
IN
05
—
64130602
—
KY
01
—
P00298628
RAILROAD MEDICARE
IN
01
—
P00711471
RAILROAD MEDICARE - KY
KY
Enumeration date
04/18/2006
Last updated
12/15/2020
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