Provider Demographics
NPI:1336128552
Name:LOGGAN, MICHAEL B (MD)
Entity Type:Individual
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First Name:MICHAEL
Middle Name:B
Last Name:LOGGAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2521 GLENN HENDREN DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3388
Mailing Address - Country:US
Mailing Address - Phone:816-781-8445
Mailing Address - Fax:816-781-8413
Practice Address - Street 1:2521 GLENN HENDREN DR
Practice Address - Street 2:SUITE 402
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068
Practice Address - Country:US
Practice Address - Phone:816-781-8445
Practice Address - Fax:816-781-8413
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2018-08-20
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Provider Licenses
StateLicense IDTaxonomies
MOMDR7E84207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO13710013OtherBCBS
MO202556403Medicaid
MO13710013OtherBCBS