Lisa Marie Fogt, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

036.120324 Issued in IL

Practice address

2650 Ridge Ave
Deparment of Radiology
Evanston, IL 60201-1718

Phone

(847) 570-2475

Fax

(847) 570-2942

NPI assigned

Mar 3, 2009

Last updated

Mar 3, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Endeavor Health Medical Group

  dba NorthShore University HealthSystem Faculty Practice Associates

  • Emergency Medicine Physician
  • Evanston, IL
  • NPI 1497701882
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1236038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236038400000",
    "number": "1699915660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 S EUCLID AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603042067",
            "telephone_number": "708-386-9124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "address_2": "DEPARMENT OF RADIOLOGY",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-2475",
            "fax_number": "847-570-2942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOGT",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-03",
        "last_updated": "2009-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036.120324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Patriarca Flora, PA-C
• Nancy Flowers
• Savannah Flowers
• Fmdce/ Montclare Physical Therapy (Montclare Physical Therapy)
• Ellie E Fogel
• Amanda Christine Foley, M.D.
• Robin Elizabeth Foley, SLP
• Dickelle Fonda, LCSW
• Kristen Fontana
• Janice B Footlik, MA LCPC NCC CCCJS NA

• Diagnostic Radiology Physician in Evanston, IL
• Providers in Evanston, IL by specialty
• Diagnostic Radiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.