Individual
MAURA LYNN BAGOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2701 TROY CENTER DR, SUITE 260, TROY, MI 48084-4753
(248) 244-8545
(248) 244-8582
Mailing address
671 E BIG BEAVER RD, STE 111, TROY, MI 48083-1421
(248) 244-8545
(248) 244-8582
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MB011649
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1156303474
BCBSM
MI
01
—
383368662
COMMERCIAL
MI
05
—
4130308
—
MI
Enumeration date
07/05/2006
Last updated
03/01/2020
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