Provider Demographics
NPI:1083620306
Name:VOGE, GRETCHEN A (MD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:A
Last Name:VOGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9325 UPLAND LN N STE 360
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4200
Mailing Address - Country:US
Mailing Address - Phone:888-455-2229
Mailing Address - Fax:
Practice Address - Street 1:9875 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4648
Practice Address - Country:US
Practice Address - Phone:888-455-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48694208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN656187000Medicaid
MNI 56301Medicare UPIN
MN370003739Medicare PIN
MN370004225Medicare PIN
MN370003188Medicare PIN