# BRIAN J. LOGUE MD. PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Summit Urology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285604199
- **Authorized official:** BRIAN J LOGUE MD (OWNER)
- **Authorized official phone:** (812) 332-8765

## Contact information

- **Practice address:** 2907 S. MCINTIRE DR, BLOOMINGTON, IN 47403-4224
- **Practice address phone:** (812) 332-8765
- **Practice address fax:** (812) 336-3425
- **Mailing address:** 2907 MCINTYRE DR, BLOOMINGTON, IN 47403-4209
- **Mailing address phone:** (812) 332-8765
- **Mailing address fax:** (812) 336-3425

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/24/2006
- **Last updated:** 01/16/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000098138 | ANTHEM BLUE SHIELD | IN |
| 05 | — | 200175020A | — | IN |
| 01 | — | CD6715 | TRAVELERS MEDICARE | IN |