Healthcare Provider Details

I. General information

NPI: 1902882640
Provider Name (Legal Business Name): RAYMOND ROBERT OGREN A.T.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3108 S RT. 59 SUITE 136
NAPERVILLE IL
60564
US

IV. Provider business mailing address

745 SPRINGDALE DRIVE 5
NAPERVILLE IL
60540-3747
US

V. Phone/Fax

Practice location:
  • Phone: 630-922-3844
  • Fax: 630-922-3845
Mailing address:
  • Phone: 630-369-1091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: