Provider Demographics
NPI:1437195302
Name:OGANOWSKI, KASIMIR (MD)
Entity Type:Individual
Prefix:
First Name:KASIMIR
Middle Name:
Last Name:OGANOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7068 MEEKER COMMONS LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2000
Mailing Address - Country:US
Mailing Address - Phone:937-890-8617
Mailing Address - Fax:
Practice Address - Street 1:200 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2400
Practice Address - Country:US
Practice Address - Phone:419-394-3335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041231207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH27036123000OtherBWC
OH3903304OtherUHC CCC
OH000000342356OtherANTHEM CCC
OH0361942Medicaid
OH3920481OtherUHC ER
OH000000342356OtherANTHEM CCC
OHP00049156Medicare ID - Type UnspecifiedRAILROAD
OH0361942Medicaid
OH0789854Medicare PIN
OH3920481OtherUHC ER