Provider Demographics
NPI:1902882640
Name:OGREN, RAYMOND ROBERT (ATC)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:ROBERT
Last Name:OGREN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 SPRINGDALE DRIVE 5
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-3747
Mailing Address - Country:US
Mailing Address - Phone:630-369-1091
Mailing Address - Fax:
Practice Address - Street 1:3108 S RT. 59
Practice Address - Street 2:SUITE 136
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564
Practice Address - Country:US
Practice Address - Phone:630-922-3844
Practice Address - Fax:630-922-3845
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist