Provider Demographics
NPI:1730297789
Name:KOGAN, MICHAEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:KOGAN
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 1:2350 ROYAL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4719
Mailing Address - Country:US
Mailing Address - Phone:847-931-5300
Mailing Address - Fax:847-931-9072
Practice Address - Street 1:2350 ROYAL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4719
Practice Address - Country:US
Practice Address - Phone:847-931-5300
Practice Address - Fax:847-931-9072
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090418207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
200023140OtherRR MEDICARE PROV
207906OtherMEDICARE GRP MCHENRY
208821OtherMEDICARE GRP KANE
CG2631OtherRR MEDICARE GRP MCH
IL036090418Medicaid
CE6001OtherRR MEDICARE GRP KANE
ILK02957Medicare ID - Type UnspecifiedMCHENRY COUNTY
IL036090418Medicaid
IL0354460002Medicare NSC
G15270Medicare UPIN
IL0354460003Medicare NSC
IL0354460004Medicare NSC
207906OtherMEDICARE GRP MCHENRY
IL0354460001Medicare NSC