Provider Demographics
NPI:1477714830
Name:WINK, LOGAN K (MD)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:K
Last Name:WINK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4790 RED BANK RD STE 212
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-1509
Mailing Address - Country:US
Mailing Address - Phone:513-906-5476
Mailing Address - Fax:513-283-0163
Practice Address - Street 1:4790 RED BANK RD STE 212
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-1509
Practice Address - Country:US
Practice Address - Phone:513-906-5476
Practice Address - Fax:513-283-0163
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY528562084P0804X
OH35.0995072084P0804X
OH390995072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY52856OtherKY LICENSE
KY7100216050Medicaid