Healthcare Provider Details

I. General information

NPI: 1376239558
Provider Name (Legal Business Name): HERBERT LUKE OGDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 06/10/2023
Certification Date: 06/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 JOHN R ST
DETROIT MI
48201-2018
US

IV. Provider business mailing address

357 CHANNING ST
FERNDALE MI
48220-2555
US

V. Phone/Fax

Practice location:
  • Phone: 313-993-4030
  • Fax:
Mailing address:
  • Phone: 720-936-4547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: