MEDICARE: DR. JUSTIN O OGBEVOEN MD

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	208000000X	Pediatrics Physician	103771	MO
2	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	103771	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487612370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN O OGBEVOEN MD

Provider Business Mailing Address
First Line	:	PO BOX 7412011
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-2011
Country	:	US
Telephone Number	:	314-454-2341
Fax Number	:	314-454-4345

Provider Business Practice Location Address
First Line	:	1225 GRAHAM RD
Second Line	:	DIV PED EMERGENCY MED
City	:	FLORISSANT
State	:	MO
Zip	:	63031-8012
Country	:	US
Telephone Number	:	314-454-2341
Fax Number	:	314-454-4345

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	04/17/2025

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Directions to “ DR. JUSTIN O OGBEVOEN MD” Practice Location

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