Provider Demographics
NPI:1043201387
Name:OGGOIAN, ROSANNE (DO)
Entity Type:Individual
Prefix:MRS
First Name:ROSANNE
Middle Name:
Last Name:OGGOIAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 N MCKINLEY RD
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1849
Mailing Address - Country:US
Mailing Address - Phone:847-735-9330
Mailing Address - Fax:847-735-9301
Practice Address - Street 1:50 S MILWAUKEE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-9471
Practice Address - Country:US
Practice Address - Phone:847-356-5747
Practice Address - Fax:847-356-5886
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2080A0000X2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04926673OtherBCBS