Healthcare Provider Details

I. General information

NPI: 1629087085
Provider Name (Legal Business Name): WALTER C VOGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 E. HUEBBE PARKWAY BELOIT HEALTH SYSTEM INC
BELOIT WI
53511-1842
US

IV. Provider business mailing address

1905 E. HUEBBE PARKWAY BELOIT HEALTH SYSTEM INC
BELOIT WI
53511-1842
US

V. Phone/Fax

Practice location:
  • Phone: 608-364-1460
  • Fax: 608-364-1271
Mailing address:
  • Phone: 608-364-1460
  • Fax: 608-364-1271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number28297020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036-062858
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: