Healthcare Provider Details

I. General information

NPI: 1881654457
Provider Name (Legal Business Name): MARK E VOGEL PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6379 SILVER LAKE RD
LINDEN MI
48451-8706
US

IV. Provider business mailing address

6379 SILVER LAKE RD
LINDEN MI
48451-8706
US

V. Phone/Fax

Practice location:
  • Phone: 810-304-7227
  • Fax:
Mailing address:
  • Phone: 810-304-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number007133
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: