Provider Demographics
NPI:1881654457
Name:VOGEL, MARK E (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:VOGEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6379 SILVER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-8706
Mailing Address - Country:US
Mailing Address - Phone:810-304-7227
Mailing Address - Fax:
Practice Address - Street 1:6379 SILVER LAKE RD
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:MI
Practice Address - Zip Code:48451-8706
Practice Address - Country:US
Practice Address - Phone:810-304-7227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI007133103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIR66694Medicare UPIN
MIOB54541Medicare ID - Type Unspecified