Provider Demographics
NPI:1093963340
Name:BRIAN N. OGAN, MD
Entity Type:Organization
Organization Name:BRIAN N. OGAN, MD
Other - Org Name:ILLINOIS SPINE AND PAIN CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:OGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-953-9793
Mailing Address - Street 1:2466 MOMENTUM PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-0001
Mailing Address - Country:US
Mailing Address - Phone:816-461-8288
Mailing Address - Fax:816-461-6586
Practice Address - Street 1:901 MEDICAL PARK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2191
Practice Address - Country:US
Practice Address - Phone:312-953-9793
Practice Address - Fax:816-461-6586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty