Individual
MRS. POLYA BAGHELAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
211 N EDDY ST, SOUTH BEND, IN 46617-3096
(574) 237-9203
(574) 237-9311
Mailing address
211 N EDDY ST, SOUTH BEND, IN 46617-3096
(574) 237-9203
(574) 237-9311
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01079934A
IN
2085R0202X
Diagnostic Radiology Physician
4301084401
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4626106
—
MI
01
—
P00214790
RAILROAD MEDICARE
—
Enumeration date
06/20/2006
Last updated
04/20/2018
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