Healthcare Provider Details

I. General information

NPI: 1346356615
Provider Name (Legal Business Name): OGAWA DERMATOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 N SQUIRREL RD SUITE 200
AUBURN HILLS MI
48326-4600
US

IV. Provider business mailing address

2251 N SQUIRREL RD SUITE 200
AUBURN HILLS MI
48326-4600
US

V. Phone/Fax

Practice location:
  • Phone: 248-340-9465
  • Fax: 248-340-9746
Mailing address:
  • Phone: 248-340-9465
  • Fax: 248-340-9746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4301029328
License Number StateMI

VIII. Authorized Official

Name: CATHERINE MCCONNELL OGAWA
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 248-340-9465