Provider Demographics
NPI:1720035074
Name:VOGEL, RODERICK S (DO)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:S
Last Name:VOGEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:VOGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:2940 HEALTH PKWY
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9342
Mailing Address - Country:US
Mailing Address - Phone:989-953-5320
Mailing Address - Fax:989-953-5329
Practice Address - Street 1:2940 HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-9342
Practice Address - Country:US
Practice Address - Phone:989-953-5320
Practice Address - Fax:989-953-5329
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012570207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4426956Medicaid
G13669Medicare UPIN
0N52880003Medicare ID - Type Unspecified