Individual
MARK WW BOGEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2601 CENTENNIAL DR STE 100, NORTH ST PAUL, MN 55109-3087
(651) 777-7414
(651) 748-5839
Mailing address
2025 SLOAN PL STE 35, SAINT PAUL, MN 55117-2092
(651) 772-1572
(651) 772-1889
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
40645
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
059723600
—
MN
Enumeration date
08/02/2006
Last updated
04/16/2019
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