Provider Demographics
NPI:1598834194
Name:OGNEN, LEO MIHAJLO (MD)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:MIHAJLO
Last Name:OGNEN
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:PO BOX 198
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-0198
Mailing Address - Country:US
Mailing Address - Phone:248-569-5100
Mailing Address - Fax:248-569-4774
Practice Address - Street 1:18597 W 10 MILE RD
Practice Address - Street 2:STE #1
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2663
Practice Address - Country:US
Practice Address - Phone:248-569-5100
Practice Address - Fax:248-569-4774
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301057142OtherSTATE LICENSE
MI4301057142OtherSTATE LICENSE