Provider Demographics
NPI:1467539940
Name:OGAS, CARL ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:ANTHONY
Last Name:OGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:433 SEMINOLE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3743
Mailing Address - Country:US
Mailing Address - Phone:231-739-6226
Mailing Address - Fax:231-739-2343
Practice Address - Street 1:433 SEMINOLE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-3743
Practice Address - Country:US
Practice Address - Phone:231-739-6226
Practice Address - Fax:231-739-2343
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062711207RS0010X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4559980Medicaid
MI1106110251OtherBLUE CROSS BLUE SHIELD
MI0610047Medicare PIN