Provider Demographics
NPI:1033159850
Name:VOGEL, DAVID L (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:VOGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17404 BURKE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2242
Mailing Address - Country:US
Mailing Address - Phone:531-466-4260
Mailing Address - Fax:531-466-4304
Practice Address - Street 1:17404 BURKE ST STE 102
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2242
Practice Address - Country:US
Practice Address - Phone:531-466-4260
Practice Address - Fax:531-466-4304
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087704208600000X
NE26130208600000X, 2086S0129X
IA39451208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1033159850Medicaid
OH2670220Medicaid
NE10024981100Medicaid
OHP00409945OtherRAILROAD MEDICARE PIN
IA1033159850Medicaid
OH2670220Medicaid
IAIB2289001Medicare PIN