Organization
OG MEDICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIM ORTLIP MD (CFO)
(804) 513-6252
Entity
Organization
Contact information
Practice address
345 FRANCONIA ST, SAN FRANCISCO, CA 94110-5314
(804) 513-6252
Mailing address
345 FRANCONIA ST, SAN FRANCISCO, CA 94110-5314
(804) 513-6252
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
—
—
207YS0123X
Facial Plastic Surgery Physician
Primary
—
—
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
—
—
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
—
—
Other
Enumeration date
03/10/2022
Last updated
03/10/2022
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