DR. O'NEAL WILSON KOGER JR. (NPI# 1962599530) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962599530 |
| Entity Type | Individual |
| Full Name | DR. O'NEAL WILSON KOGER JR. |
| Credential | M.D. |
| Practice Address |
30301 Woodward Ave 120 Royal Oak MI 48302 |
| Practice Telephone | 2484356622 |
| Practice Fax Number | 2484357453 |
| Mailing Telephone | 2484356622 |
| Mailing Fax Number | 2484357453 |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2014-04-23 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 4301053536 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | RAILROAD MEDICARE | 070012496 | 01 |
| MI | NEW BCN | 632825 | 01 |
| MI | BCBS | 070F37332 | 01 |
| MI | AETNA | 4113337 | 01 |
| MI | INDIV B | 0706328251 | 01 |
| MI | 3361759 | 05 | |
| MI | CIGNA | 9679933 | 01 |
| MI | OLD BCN | P67011 | 01 |
| MI | HAP | S38359 | 01 |
| Street Address |
30301 WOODWARD AVE 120 |
| City | ROYAL OAK |
| State | MI |
| Zip Code | 48302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144313107 | Cheryl Hope Hack | Pediatrics | 30301 Woodward Ave, Suite Ll 165, Royal Oak, MI 48073-0979 | 2006-10-02 |
| 1225576085 | Malhotra & Renusch Dds PC | Dentist | 30301 Woodward Ave, Ste. 220, Royal Oak, MI 48073-0979 | 2017-02-01 |
| 1023411972 | Sowrabh Paspulati Saibaba | Physical Therapist | 30301 Woodward Ave, Suite 200, Royal Oak, MI 48073-0979 | 2014-10-07 |
| 1184044976 | Michigan Pain Management LLC | Pain Medicine | 30301 Woodward Ave, Suite 240, Royal Oak, MI 48073-0979 | 2014-04-21 |
| 1184985145 | North Shore Injury Center, Inc. | Chiropractor | 30301 Woodward Ave, Suite 200, Royal Oak, MI 48073-0979 | 2012-06-06 |
| 1407986201 | Rhodonna Marie Anderson | Podiatrist | 30301 Woodward Ave, Suite 120, Royal Oak, MI 48073-0979 | 2007-03-07 |
| 1083768147 | Loren E. Hollander | Psychologist | 30301 Woodward Ave, Suite Ll165, Royal Oak, MI 48073-0979 | 2007-01-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386242634 | Lamuriel Lewis | Registered Nurse | 1430 South Telegraph Rd, Bloomfield Hills, MI 48302 | 2020-10-09 |
| 1730794082 | Ola Glezen | Registered Nurse | 1410 South Telegraph Road, Bloomfield Hills, MI 48302 | 2020-09-14 |
| 1114563400 | Henry Ford Health System | Pharmacy | 1961 S Telegraph Rd, Bloomfield Twp, MI 48302 | 2019-11-21 |
| 1508407982 | P-cor LLC | Eyewear Supplier (Equipment, not the service) | 1961 S. Telegraph Rd, Bloomfield Hills, MI 48302 | 2019-10-07 |
| 1144887936 | Christine Beth Wilson De Medina | Psychologist | W-4111 Andover Road, Bloomfield Hills, MI 48302 | 2019-05-28 |
| 1942793799 | Andrew Joseph Grix | Physical Therapist | 2525 S Telegraph Rd Ste 314, Bloomfield Hills, MI 48302 | 2018-06-06 |
| 1306398078 | Shaleene Mayo | Mechanotherapist | 43902 Woodward # 120, Bloomfield Hills, MI 48302 | 2016-10-28 |
| 1588112981 | Carol Van Kampen | Social Worker | 2550 S. Telegraph, Bloomfield Hills, MI 48302 | 2016-09-14 |
| 1770933848 | Rachelle Savalli | Family Medicine | 1961 South Telegraph Rd, Bloomfield Twp, MI 48302 | 2016-06-20 |
| 1699155366 | Aleksey Mishulin | Ophthalmology | 1750 S Telegraph Ste 205, Bloomfield Hills, MI 48302 | 2015-06-08 |
| Find all providers in zip 48302 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710595616 | Diamond Dermatology, Pllc. | Dermatology | 3206 N Main St, Royal Oak, MI 48073-3424 | 2020-07-16 |
| 1245744242 | Maureen Cliffel Do Pllc | Dermatology | 26454 Woodward Ave Ste 200, Royal Oak, MI 48067-0969 | 2017-11-29 |
| 1942370507 | Koger Dermatology P.C. | Dermatology | 30301 Woodward Ave Ste 120, Royal Oak, MI 48073-0981 | 2006-11-09 |
| 1205875085 | Janet Lynn Koprince | Dermatology | 713 N Main St, Royal Oak, MI 48067-1835 | 2006-06-06 |
| 1881659399 | Maureen T Cliffel | Dermatology | 26454 Woodward Ave, Ste 200, Royal Oak, MI 48067-0969 | 2006-04-18 |
| 1821298167 | Koprince Dermatology Plc | Dermatology | 713 N Main St, Royal Oak, MI 48067-1835 | 2007-07-24 |
| 1255371670 | Joanna Gammons | Dermatology | 713 N Main St, Royal Oak, MI 48067-1835 | 2006-06-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477179174 | Alicia Scopis | Dermatology | 50505 Schoenherr Rd Ste 325, Shelby Township, MI 48315-3142 | 2020-06-18 |
| 1003460874 | Derm Institute of West Michigan Plc | Dermatology | 6750 Kalamazoo Ave, Suites C & D, Grand Rapids, MI 49508 | 2019-07-30 |
| 1770080939 | Emily Rose Davis | Dermatology | 5333 Mcauley Dr Rm 2111, Ypsilanti, MI 48197-1097 | 2018-04-12 |
| 1306375365 | Lindsay Christina El Awadi | Dermatology | 50182 Schoenherr Rd, Shelby Twp, MI 48315-3136 | 2017-06-05 |
| 1396278099 | Sasank Konda | Dermatology | 3031 W. Grand Blvd., 8th Floor, Dept. of Dermatology, Detroit, MI 48202 | 2017-04-10 |
| 1790132439 | Saara Kanervikkoaho-crane | Dermatology | 1517 Granger Ave, Ann Arbor, MI 48104-4426 | 2016-05-23 |
| 1588019053 | Legacy Dermatology Group PC | Dermatology | 1392 S Cass Lake Rd, Waterford, MI 48328 | 2016-05-03 |
| 1679955041 | Luke D Killpack | Dermatology | 5333 Mcauley Dr Rm 5003, Ypsilanti, MI 48197-1020 | 2015-06-22 |
| 1225410756 | Kelsey Louise Lawrence | Dermatology | 849 Health Park Blvd, Grand Blanc, MI 48439-7383 | 2015-06-20 |
| 1558756833 | Stacie Clark | Dermatology | 6700 N Rochester Rd Ste 112, Rochester Hills, MI 48306-4378 | 2015-04-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.