Provider Demographics
NPI:1396883005
Name:VOGEL, JEAN E (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:E
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 1:1100 LAKE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-6799
Mailing Address - Country:US
Mailing Address - Phone:715-848-4600
Mailing Address - Fax:203-267-7674
Practice Address - Street 1:1100 LAKE VIEW DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-6799
Practice Address - Country:US
Practice Address - Phone:715-848-4600
Practice Address - Fax:203-267-7674
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI765222084P0800X
CT0325122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G26492Medicare UPIN