Healthcare Provider Details

I. General information

NPI: 1437195302
Provider Name (Legal Business Name): KASIMIR OGANOWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SAINT CLAIR AVE
SAINT MARYS OH
45885-2400
US

IV. Provider business mailing address

7068 MEEKER COMMONS LN
DAYTON OH
45414-2000
US

V. Phone/Fax

Practice location:
  • Phone: 419-394-3335
  • Fax:
Mailing address:
  • Phone: 937-890-8617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35041231
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: