Healthcare Provider Details

I. General information

NPI: 1255648010
Provider Name (Legal Business Name): CORY ALAN OGDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 W TAYLOR ST # 227
CHICAGO IL
60607-4623
US

IV. Provider business mailing address

1440 W TAYLOR ST # 227
CHICAGO IL
60607-4623
US

V. Phone/Fax

Practice location:
  • Phone: 888-805-0085
  • Fax:
Mailing address:
  • Phone: 888-805-0085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD158367
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number036.171205
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: