Individual
DR. LISA MARIE FOGT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2650 RIDGE AVE, DEPARMENT OF RADIOLOGY, EVANSTON, IL 60201-1718
(847) 570-2475
(847) 570-2942
Mailing address
930 S EUCLID AVE, OAK PARK, IL 60304-2067
(708) 386-9124
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036.120324
IL
Other
Enumeration date
03/03/2009
Last updated
03/03/2009
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