Provider Demographics
NPI:1689635666
Name:VOGEL, MARK A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:VOGEL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 N PLUM GROVE RD
Mailing Address - Street 2:STE C
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5144
Mailing Address - Country:US
Mailing Address - Phone:847-413-9700
Mailing Address - Fax:847-413-1701
Practice Address - Street 1:919 N PLUM GROVE RD
Practice Address - Street 2:STE C
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5144
Practice Address - Country:US
Practice Address - Phone:847-413-9700
Practice Address - Fax:847-413-1701
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005719103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
K16330Medicare UPIN
K16329Medicare UPIN