Provider Demographics
NPI:1326364654
Name:VOGEL, ADAM MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MARK
Last Name:VOGEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8235
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-454-6070
Mailing Address - Fax:314-454-2442
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:STE A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6070
Practice Address - Fax:314-454-2442
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2015-10-23
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Provider Licenses
StateLicense IDTaxonomies
MO2012003519208600000X, 2086S0102X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Medicaid