Individual
FAY BAGARINAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
155 E BETHALTO DR, BETHALTO, IL 62010-1801
(618) 377-8961
Mailing address
155 E BETHALTO DR, BETHALTO, IL 62010-1801
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036107093
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0361070933
—
IL
Enumeration date
08/16/2006
Last updated
07/08/2007
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