Provider Demographics
NPI:1487611638
Name:VOGELBACH, KARL HEINER (MD)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:HEINER
Last Name:VOGELBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S 1ST AVE
Mailing Address - Street 2:STE C
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7526
Mailing Address - Country:US
Mailing Address - Phone:626-247-9202
Mailing Address - Fax:626-566-2704
Practice Address - Street 1:900 S 1ST AVE
Practice Address - Street 2:STE E
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-7526
Practice Address - Country:US
Practice Address - Phone:626-247-9202
Practice Address - Fax:626-566-2704
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29514207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00133463OtherRAIL ROAD MEDICARE
CAA29514OtherBLUE SHIELD
CAP00133463OtherRAIL ROAD MEDICARE
CAHH573ZMedicare PIN