Individual
DR. BRENT ALAN BAGLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(888) 484-3258
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01083598A
IN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
01083598A
IN
207RP1001X
Pulmonary Disease Physician
Primary
01083598A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11019260A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264910405
MEDICARE PTAN
IN
05
—
300066502
—
IN
Enumeration date
05/27/2017
Last updated
03/08/2025
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