Healthcare Provider Details

I. General information

NPI: 1467540781
Provider Name (Legal Business Name): LOGANSPORT FAMILY HEALTH CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 MICHIGAN AVENUE SUITE 270
LOGANSPORT IN
46947-1530
US

IV. Provider business mailing address

1201 MICHIGAN AVENUE SUITE 270
LOGANSPORT IN
46947-1530
US

V. Phone/Fax

Practice location:
  • Phone: 574-722-4921
  • Fax: 574-739-0520
Mailing address:
  • Phone: 574-722-4921
  • Fax: 574-739-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50003710A
License Number StateIN

VIII. Authorized Official

Name: DR. CORY S NEUMANN
Title or Position: PRESIDENT OF CORPORATION
Credential: M.D.
Phone: 574-722-4921