Individual
LOGAN ANDREW SHIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2139 AUBURN AVE, CINCINNATI, OH 45219-2906
(513) 792-7445
(513) 791-4042
Mailing address
2139 AUBURN AVE, CINCINNATI, OH 45219-2906
(513) 792-7445
(513) 791-4042
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.006704
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0496432
—
OH
Enumeration date
11/22/2019
Last updated
09/20/2022
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