MEDICARE: MRS. JUDITH ANN OGARA LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian		IL

General Provider Information

NPI Number	:	1922058742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDITH ANN OGARA LD

Provider Business Mailing Address
First Line	:	740 LARAMIE AVE
Second Line	:
City	:	WILMETTE
State	:	IL
Zip	:	60091-2052
Country	:	US
Telephone Number	:	847-688-3446
Fax Number	:

Provider Business Practice Location Address
First Line	:	NAVAL HOSPITAL GREAT LAKES
Second Line	:	3001A 6TH STREET BLDG 200H
City	:	GREAT LAKES
State	:	IL
Zip	:	60088-2811
Country	:	US
Telephone Number	:	847-688-3446
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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