Individual
MARK LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1401 PROFESSIONAL BLVD, EVANSVILLE, IN 47714-8014
(812) 473-2060
(812) 473-0763
Mailing address
1401 PROFESSIONAL BLVD, EVANSVILLE, IN 47714-8014
(812) 473-2060
(812) 473-0763
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
01046534A
IN
207Y00000X
Otolaryngology Physician
32870
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000045660
ANTHEM
IN
01
—
000000045660
ANTHEM
KY
01
—
040003023
RR MEDICARE
KY
01
—
064945
HEALTH ALLIANCE
IN
05
—
200149220A
—
IN
01
—
394258
HEALTHLINK
IN
05
—
64328701
—
KY
01
—
P00076697
RR MEDICARE
IN
Enumeration date
10/17/2005
Last updated
06/30/2025
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