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Organization
BRIAN J. LOGUE MD. PC
Active
Organization
BRIAN J. LOGUE MD. PC
Active
Other names
Summit Urology
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN J LOGUE MD (OWNER)
(812) 332-8765
Entity
Organization
Contact information
Practice address
2907 S. MCINTIRE DR, BLOOMINGTON, IN 47403-4224
(812) 332-8765
(812) 336-3425
Mailing address
2907 MCINTYRE DR, BLOOMINGTON, IN 47403-4209
(812) 332-8765
(812) 336-3425
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
NULL
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000098138
ANTHEM BLUE SHIELD
IN
05
—
200175020A
—
IN
01
—
CD6715
TRAVELERS MEDICARE
IN
Enumeration date
01/24/2006
Last updated
01/16/2018
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