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NPI Code Detail

MEDICARE: DR. MARVIN LEROY LOGEL PH.D.

MEDICARE: DR. MARVIN LEROY LOGEL PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistLP0569MN
2103T00000XPsychologistPY7902FL
3103TC0700XClinical PsychologistPY7902FL
4103TP0814XPsychoanalysis PsychologistPY7902FL
5103TP0814XPsychoanalysis PsychologistLP0569MN
6103TC0700XClinical PsychologistLP0569MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110076LOOTHERMNBLUE-CROSS BLUE-SHIELD

General Provider Information

NPI Number : 1447376348
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARVIN LEROY LOGEL PH.D.
Provider Business Mailing Address
First Line : 301 ALTARA AVE APT 519
Second Line :
City : CORAL GABLES
State : FL
Zip : 33146-1465
Country : US
Telephone Number : 952-221-7166
Fax Number : 952-937-0925
Provider Business Practice Location Address
First Line : 5200 WILLSON RD STE 150
Second Line :
City : EDINA
State : MN
Zip : 55424-1300
Country : US
Telephone Number : 952-221-7166
Fax Number : 952-937-0925
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 01/12/2025

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