Provider Demographics
NPI:1124361142
Name:VOGEL, RYAN N (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:N
Last Name:VOGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:385 WILLIAMSTOWNE STE 101
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2323
Mailing Address - Country:US
Mailing Address - Phone:262-510-0300
Mailing Address - Fax:262-510-0500
Practice Address - Street 1:385 WILLIAMSTOWNE STE 101
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2323
Practice Address - Country:US
Practice Address - Phone:262-510-0300
Practice Address - Fax:262-510-0500
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI62787207WX0107X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1124361142Medicaid
WI62787OtherWI STATE LICENSE
14446651OtherCAQH
000001467755OtherAMERICAN ACADEMY OF OPHTHALMOLOGY
000001467755OtherAMERICAN ACADEMY OF OPHTHALMOLOGY