Individual
MR. MICHAEL STEPHEN LOGUE
Active
Individual
MR. MICHAEL STEPHEN LOGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FAM NRS PRAC FNP
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
Update your record
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