Healthcare Provider Details

I. General information

NPI: 1194777052
Provider Name (Legal Business Name): KEVIN J LOGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 EDWARDS MILL RD SUITE 200
RALEIGH NC
27612-5243
US

IV. Provider business mailing address

3001 EDWARDS MILL RD STE 200
RALEIGH NC
27612-5243
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-5600
  • Fax: 919-782-6578
Mailing address:
  • Phone: 919-781-5600
  • Fax: 919-863-6821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number2005-00708
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2005-00708
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: