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General NPI Number Information
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NPI Number | 1720077407
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Entity Type | Individual
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Provider Name | MARK LOGAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 1401 PROFESSIONAL BLVD
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City | EVANSVILLE
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State | IN
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Zip | 47714-8014
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Country | US
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Telephone | 812-473-2060
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Fax | 812-473-0763
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Provider Business Mailing Address
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Address Line | 1401 PROFESSIONAL BLVD
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City | EVANSVILLE
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State | IN
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Zip | 47714-8014
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Country | US
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Telephone | 812-473-2060
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Fax | 812-473-0763
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 32870
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 01046534A
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License Number State | IN
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