Provider Demographics
NPI:1477551042
Name:LOGEMAN, WILLIAM J (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:LOGEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24999 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-9783
Mailing Address - Country:US
Mailing Address - Phone:812-637-2802
Mailing Address - Fax:
Practice Address - Street 1:5141 MORNING SUN RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-9629
Practice Address - Country:US
Practice Address - Phone:513-523-2156
Practice Address - Fax:513-523-2503
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045684L208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH130910003OtherCARESOURCE
OH010587697026OtherHUMANA
OH633854OtherAETNA
OH000000216596OtherANTHEM
OH0647474Medicaid
OH1201304OtherUNITED HEALTHCARE
OHD33267Medicare UPIN