Provider Demographics
NPI:1922056787
Name:WOGAHN, BRENT M (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:M
Last Name:WOGAHN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:719 W HAMILTON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6968
Mailing Address - Country:US
Mailing Address - Phone:715-832-1044
Mailing Address - Fax:715-832-0520
Practice Address - Street 1:719 W HAMILTON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6968
Practice Address - Country:US
Practice Address - Phone:715-832-1044
Practice Address - Fax:715-832-0520
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-12-17
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Provider Licenses
StateLicense IDTaxonomies
WI36446208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI17-13730OtherSELECT CARE/MEDICA
WI020031295OtherRAILROAD MEDICARE
WIHP60437OtherHEALTH PARTNERS
WI32105900Medicaid
WI38718OtherSECURITY HEALTH PLAN
WI17-13730OtherSELECT CARE/MEDICA
WIHP60437OtherHEALTH PARTNERS