Provider Demographics
NPI:1821057563
Name:VOGEL, JULIE K (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:K
Last Name:VOGEL
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 1:6936 PINE ARBOR DR S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4645
Mailing Address - Country:US
Mailing Address - Phone:651-326-5800
Mailing Address - Fax:651-326-5802
Practice Address - Street 1:6936 PINE ARBOR DR S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4645
Practice Address - Country:US
Practice Address - Phone:651-326-5800
Practice Address - Fax:651-326-5802
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN30781207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN477785900Medicaid
080003931Medicare ID - Type Unspecified
A03200Medicare UPIN