Healthcare Provider Details

I. General information

NPI: 1275853335
Provider Name (Legal Business Name): MICHAEL PATRICK OGILVIE MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 95TH ST STE 102
OAK LAWN IL
60453-2655
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-4198
  • Fax: 708-684-4755
Mailing address:
  • Phone: 847-390-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number036-140403
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: