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General NPI Number Information
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NPI Number | 1245295468
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Entity Type | Individual
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Provider Name | MANISHA J OGALE MD
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Gender | Female
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 45 W 111TH STREET ROSELAND COMMUNITY HOSPITAL
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City | CHICAGO
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State | IL
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Zip | 60628
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Country | US
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Telephone | 773-995-3000
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Fax | 630-734-1560
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Provider Business Mailing Address
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Address Line | 15900 S CICERO AVE
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City | OAK FOREST
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State | IL
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Zip | 60452-4006
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Country | US
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Telephone | 708-633-4292
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036110259
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License Number State | IL
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