Healthcare Provider Details

I. General information

NPI: 1013965615
Provider Name (Legal Business Name): EDWARD G VOGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2641 DEVELOPMENT DR
GREEN BAY WI
54311-4240
US

IV. Provider business mailing address

PO BOX 5277
DE PERE WI
54115-5277
US

V. Phone/Fax

Practice location:
  • Phone: 920-338-6868
  • Fax: 920-338-6869
Mailing address:
  • Phone: 920-338-6868
  • Fax: 920-338-6869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number17938
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: