Individual
RYAN LOGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8040 CLEARVISTA PKWY STE 440, INDIANAPOLIS, IN 46256-4673
(317) 621-5510
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-7547
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
01087732A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Q00369282
RAILROAD MEDICARE
IN
Enumeration date
04/01/2016
Last updated
07/22/2024
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