Provider Demographics
NPI:1780076687
Name:HOGAN, DAVID (CASE MANAGER/CARE CO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HOGAN
Suffix:
Gender:M
Credentials:CASE MANAGER/CARE CO
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:HOGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASE MANAGER/CARE CO
Mailing Address - Street 1:2105 N MERIDIAN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1491
Mailing Address - Country:US
Mailing Address - Phone:317-926-5463
Mailing Address - Fax:317-926-5498
Practice Address - Street 1:2105 N MERIDIAN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1491
Practice Address - Country:US
Practice Address - Phone:317-926-5463
Practice Address - Fax:317-926-5498
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator