Individual
MICHAEL LEO HOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3900 ST FRANCIS WAY STE 200, LAFAYETTE, IN 47905-4940
(765) 775-2800
(765) 775-2831
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01065848A
IN
207RC0000X
Cardiovascular Disease Physician
Primary
01065848A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000586631
ANTHEM PROVIDER NUMBER
IN
05
—
03607032 1
—
IL
01
—
101 15504
B/C B/S OF ILLINOIS
IL
05
—
200917540
—
IN
01
—
CB0709/060019665
RR MEDICARE GROUP ID#/PIN
GA
Enumeration date
07/13/2006
Last updated
10/03/2023
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