Provider Demographics
NPI:1639384183
Name:LOGAN, KEVIN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:LOGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8499 FISHERS CENTER DR.
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2318
Mailing Address - Country:US
Mailing Address - Phone:317-598-4325
Mailing Address - Fax:317-598-4326
Practice Address - Street 1:8499 FISHERS CENTER DR.
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2318
Practice Address - Country:US
Practice Address - Phone:317-598-4325
Practice Address - Fax:317-598-4326
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2014-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01052474A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING83689Medicare UPIN