Provider Demographics
NPI:1003421603
Name:BARKLEY, LOGAN MICHAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:MICHAEL
Last Name:BARKLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 WARRENVILLE RD STE 280
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2075
Mailing Address - Country:US
Mailing Address - Phone:630-324-7934
Mailing Address - Fax:
Practice Address - Street 1:2560 24TH ST STE 201
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5390
Practice Address - Country:US
Practice Address - Phone:309-779-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty