Individual
THEODORE F LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
535 BARNHILL DR, RT 473, INDIANAPOLIS, IN 46202-5112
(317) 278-7576
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01051224A
IN
207RH0003X
Hematology & Oncology Physician
01051224
IN
207RH0003X
Hematology & Oncology Physician
Primary
01051224A
IN
207RX0202X
Medical Oncology Physician
01051224A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000109649
ANTHEM PTAN
IN
05
—
200243290
—
IN
Enumeration date
04/20/2006
Last updated
03/13/2025
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