Healthcare Provider Details

I. General information

NPI: 1114911351
Provider Name (Legal Business Name): JOHN M OGRADY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2393 SCHUST RD
SAGINAW MI
48603-1334
US

IV. Provider business mailing address

2393 SCHUST RD
SAGINAW MI
48603-1334
US

V. Phone/Fax

Practice location:
  • Phone: 989-793-2820
  • Fax: 989-793-9132
Mailing address:
  • Phone: 989-793-2820
  • Fax: 989-793-9132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301054868
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: