1093963340 NPI number — BRIAN N. OGAN, MD

Table of content: (NPI 1093963340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093963340 NPI number — BRIAN N. OGAN, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIAN N. OGAN, MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093963340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2466 MOMENTUM PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60689-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-461-8288
Provider Business Mailing Address Fax Number:
816-461-6586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
EFFINGHAM
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62401-2191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-953-9793
Provider Business Practice Location Address Fax Number:
816-461-6586
Provider Enumeration Date:
08/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
OGAN
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
312-953-9793

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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