Healthcare Provider Details

I. General information

NPI: 1396770020
Provider Name (Legal Business Name): HARLE LAUREN VOGEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 LANE 230 JIMMERSON LK
ANGOLA IN
46703-9493
US

IV. Provider business mailing address

315 LANE 230 JIMMERSON LK
ANGOLA IN
46703-9493
US

V. Phone/Fax

Practice location:
  • Phone: 260-316-6222
  • Fax:
Mailing address:
  • Phone: 260-316-6222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02005319A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: