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Individual

KEITH W LOGIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
10212 LANTERN RD, FISHERS, IN 46037-9705
(317) 841-5656
(317) 841-5751
Mailing address
6330 E 75TH ST, SUITE 140, INDIANAPOLIS, IN 46250-2777
(317) 594-6900
(317) 594-6911

Taxonomy

Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
01031620
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100323590
IN
01
110031005
RAILROAD MEDICARE PIN
IN
Enumeration date
08/16/2005
Last updated
08/10/2012
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