Provider Demographics
NPI:1588657498
Name:OGANDZHANOVA, INNA (MD)
Entity Type:Individual
Prefix:DR
First Name:INNA
Middle Name:
Last Name:OGANDZHANOVA
Suffix:
Gender:F
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:PO BOX 13064
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85230-3064
Mailing Address - Country:US
Mailing Address - Phone:520-431-3547
Mailing Address - Fax:520-876-9765
Practice Address - Street 1:1281 E COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-2949
Practice Address - Country:US
Practice Address - Phone:520-876-0150
Practice Address - Fax:520-421-3474
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ286802085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ508533Medicaid
71303Medicare ID - Type Unspecified
G80717Medicare UPIN