MEDICARE: DR. PATRICK CLIFFORD LOGAN MD

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
1	207N00000X	Dermatology Physician	01020481A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	072068448	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992704290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK CLIFFORD LOGAN MD

Provider Business Mailing Address
First Line	:	1910 N ARLINGTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-5199
Country	:	US
Telephone Number	:	317-359-5358
Fax Number	:	317-359-5358

Provider Business Practice Location Address
First Line	:	1910 N ARLINGTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-5128
Country	:	US
Telephone Number	:	317-359-5358
Fax Number	:	317-359-5358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	10/09/2013

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