Individual
LARS OPTIMUS LOGDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1111 RONALD REAGAN PKWY, AVON, IN 46123-7085
(317) 217-3500
(317) 217-3115
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
01079959A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/08/2014
Last updated
06/14/2021
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