Healthcare Provider Details

I. General information

NPI: 1568578052
Provider Name (Legal Business Name): PAMELA OGOR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 N OAKLAND AVE 2ND FLOOR
SHOREWOOD WI
53211-2265
US

IV. Provider business mailing address

3970 N OAKLAND AVE 2ND FLOOR
SHOREWOOD WI
53211-2265
US

V. Phone/Fax

Practice location:
  • Phone: 414-527-5690
  • Fax: 414-527-5695
Mailing address:
  • Phone: 414-527-5690
  • Fax: 414-527-5695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28684
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: