Healthcare Provider Details

I. General information

NPI: 1396793832
Provider Name (Legal Business Name): ANDREW S OGAWA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 BARCLAY CIR
ROCHESTER HILLS MI
48307-4511
US

IV. Provider business mailing address

375 BARCLAY CIR
ROCHESTER HILLS MI
48307-4511
US

V. Phone/Fax

Practice location:
  • Phone: 248-852-3636
  • Fax: 248-852-3631
Mailing address:
  • Phone: 248-852-3636
  • Fax: 248-852-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberAO029327
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: