Provider Demographics
NPI:1528236692
Name:OGAWA, CATHERINE MCCONNELL (MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MCCONNELL
Last Name:OGAWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6949 ERIN WAY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2173
Mailing Address - Country:US
Mailing Address - Phone:248-879-9615
Mailing Address - Fax:
Practice Address - Street 1:6949 ERIN WAY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-2173
Practice Address - Country:US
Practice Address - Phone:248-879-9615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301029328207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0634515OtherBLUE CROSS/BLUE SHIELD
MI0634515OtherBLUE CROSS BLUE SHIELD
MI0N56420Medicare PIN