MEDICARE: RICHARD STEPHEN VOGT FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209009565	IL

General Provider Information

NPI Number	:	1811258593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD STEPHEN VOGT FNP-BC

Provider Business Mailing Address
First Line	:	1008 A ST
Second Line	:
City	:	GERMANTOWN
State	:	IL
Zip	:	62245-2030
Country	:	US
Telephone Number	:	618-407-6331
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 MARYLAND WAY # 400
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-4948
Country	:	US
Telephone Number	:	844-407-7557
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	05/13/2015

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