MEDICARE: DR. CORY ALAN OGDEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD158367	OR
2	207QA0505X	Adult Medicine Physician	036.171205	IL

General Provider Information

NPI Number	:	1255648010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORY ALAN OGDEN M.D.

Provider Business Mailing Address
First Line	:	1440 W TAYLOR ST # 227
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4623
Country	:	US
Telephone Number	:	888-805-0085
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 W TAYLOR ST # 227
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4623
Country	:	US
Telephone Number	:	888-805-0085
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2010
Last Update Date	:	04/25/2025

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