Provider Demographics
NPI:1518920669
Name:VOGT, KRISTEN L (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:VOGT
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 1:25 N. WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190
Mailing Address - Country:US
Mailing Address - Phone:630-260-0600
Mailing Address - Fax:630-260-1370
Practice Address - Street 1:25 N. WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190
Practice Address - Country:US
Practice Address - Phone:630-260-0600
Practice Address - Fax:630-260-1370
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036123565208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL920540038OtherMEDICARE PTAN (CPG INDIVIDUAL)
IL036123565Medicaid
IL920540OtherMEDICARE PTAN (CPG GROUP)
IL036123565Medicaid
I44746Medicare UPIN
ILIL3270197Medicare PIN
KY64117245Medicaid