Individual
LOGAN N SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8433 HARCOURT RD STE 100, INDIANAPOLIS, IN 46260-2193
(317) 583-7600
Mailing address
8433 HARCOURT RD STE 100, INDIANAPOLIS, IN 46260-2193
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10002617A
IN
Other
Enumeration date
11/09/2018
Last updated
06/06/2023
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