Provider Demographics
NPI:1528077948
Name:OGAN, BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:OGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 BRIERHILL RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4402
Mailing Address - Country:US
Mailing Address - Phone:217-974-9366
Mailing Address - Fax:800-801-3765
Practice Address - Street 1:1002 INTERSTATE DR STE 100
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-1465
Practice Address - Country:US
Practice Address - Phone:217-974-9366
Practice Address - Fax:800-801-3765
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101808207L00000X
IL336-067076207L00000X
IL036-101808207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00656777Medicare PIN
IL217082Medicare PIN