Individual
MR. MICHAEL STEPHEN LOGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FAM NRS PRAC FNP
Contact information
Practice address
10012 KENNERLY ROAD, SUITE # 301, ST LOUIS, MO 63128
(314) 894-0787
(314) 729-1489
Mailing address
11140 S TOWNE SQUARE, SUITE # 105, ST LOUIS, MO 63123
(314) 894-0787
(314) 729-3963
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
135879
MO
363LF0000X
Family Nurse Practitioner
209004468
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
072289
EXCLUSIVE CHOICE
MO
01
—
189482
BCBS
MO
05
—
356650631001
—
IL
05
—
429176605
—
MO
01
—
46286
HEALTHCARE USA
MO
01
—
652432
HEALTHLINK
MO
01
—
7196539
AETNA
MO
01
—
P00117390
MEDICARE RAILROAD
MO
Enumeration date
05/30/2006
Last updated
11/07/2007
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