Organization
P C LOGAN MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICK CLIFFORD LOGAN MD (PRESIDENT/OWNER)
(317) 359-5357
Entity
Organization
Contact information
Practice address
1910 N ARLINGTON AVE, INDIANAPOLIS, IN 46218-5128
(317) 359-5357
(317) 359-5358
Mailing address
1910 N ARLINGTON AVE, INDIANAPOLIS, IN 46218-5128
(317) 359-5357
(317) 359-5358
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01020481A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000082565
ANTHEM BLUE CROSS & BLUE
IN
01
—
072068448
RAILROAD MEDICARE
IN
05
—
100055560A
—
IN
Enumeration date
07/24/2007
Last updated
07/24/2007
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