Healthcare Provider Details

I. General information

NPI: 1518110030
Provider Name (Legal Business Name): MATTHEW E VOGT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SALT CREEK LN STE 300
HINSDALE IL
60521-8611
US

IV. Provider business mailing address

1775 BALLARD RD NESSET PAVILION
PARK RIDGE IL
60068-1005
US

V. Phone/Fax

Practice location:
  • Phone: 630-922-5071
  • Fax:
Mailing address:
  • Phone: 847-318-6020
  • Fax: 847-318-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036.123928
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: