Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 2080A0000X | IL |
NPI | 1043201387 |
---|---|
Provider Name | Mrs. Rosanne Oggoian |
First Address | Lake Forest, IL 60045-1849 |
Second Address | Lake Villa, IL 60046-9471 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04926673 | BCBS (01) | IL |