Healthcare Provider Details

I. General information

NPI: 1528077948
Provider Name (Legal Business Name): BRIAN OGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 INTERSTATE DR STE 100
CHAMPAIGN IL
61822-1465
US

IV. Provider business mailing address

406 BRIERHILL RD
DEERFIELD IL
60015-4402
US

V. Phone/Fax

Practice location:
  • Phone: 217-974-9366
  • Fax: 800-801-3765
Mailing address:
  • Phone: 217-974-9366
  • Fax: 800-801-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036101808
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number336-067076
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036-101808
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: