Provider Demographics
NPI:1568578052
Name:OGOR, PAMELA (DO)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:OGOR
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 1:3970 N OAKLAND AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2265
Mailing Address - Country:US
Mailing Address - Phone:414-527-5690
Mailing Address - Fax:414-527-5695
Practice Address - Street 1:3970 N OAKLAND AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2265
Practice Address - Country:US
Practice Address - Phone:414-527-5690
Practice Address - Fax:414-527-5695
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30042700Medicaid
WI30042700Medicaid
WI01600-0003Medicare ID - Type Unspecified