Provider Demographics
NPI:1669414900
Name:BOGDONOFF, GREGORY P (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:P
Last Name:BOGDONOFF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:21120 WASHINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-3112
Mailing Address - Country:US
Mailing Address - Phone:815-469-9750
Mailing Address - Fax:815-469-9752
Practice Address - Street 1:21120 WASHINGTON PKWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-3112
Practice Address - Country:US
Practice Address - Phone:815-469-9750
Practice Address - Fax:815-469-9752
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036076482174400000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist