Healthcare Provider Details

I. General information

NPI: 1528236692
Provider Name (Legal Business Name): CATHERINE MCCONNELL OGAWA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6949 ERIN WAY
TROY MI
48098-2173
US

IV. Provider business mailing address

6949 ERIN WAY
TROY MI
48098-2173
US

V. Phone/Fax

Practice location:
  • Phone: 248-879-9615
  • Fax:
Mailing address:
  • Phone: 248-879-9615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: