Healthcare Provider Details

I. General information

NPI: 1649152166
Provider Name (Legal Business Name): MS. BROOKE NICOLE OGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20300 SUPERIOR RD
TAYLOR MI
48180-6331
US

IV. Provider business mailing address

6533 E JEFFERSON AVE APT 133E
DETROIT MI
48207-3716
US

V. Phone/Fax

Practice location:
  • Phone: 248-761-9177
  • Fax:
Mailing address:
  • Phone: 248-761-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: