Provider Demographics
NPI:1346356615
Name:OGAWA DERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:OGAWA DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:MCCONNELL
Authorized Official - Last Name:OGAWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-340-9465
Mailing Address - Street 1:2251 N SQUIRREL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-4600
Mailing Address - Country:US
Mailing Address - Phone:248-340-9465
Mailing Address - Fax:248-340-9746
Practice Address - Street 1:2251 N SQUIRREL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-4600
Practice Address - Country:US
Practice Address - Phone:248-340-9465
Practice Address - Fax:248-340-9746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301029328207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0634515OtherBLUE CROSS/BLUE SHIELD
MI0634515OtherBLUE CROSS/BLUE SHIELD