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NPI Code Detail

MEDICARE: DR. DOUGLAS K. LOGAN M.D.

MEDICARE: DR. DOUGLAS K. LOGAN M.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
1207R00000XInternal Medicine Physician43241OH

Other Identifiers

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

General Provider Information

NPI Number : 1659585289
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DOUGLAS K. LOGAN M.D.
Provider Business Mailing Address
First Line : 764 SAINT THOMAS CT
Second Line :
City : CINCINNATI
State : OH
Zip : 45230-3872
Country : US
Telephone Number : 513-231-7229
Fax Number : 513-579-0444
Provider Business Practice Location Address
First Line : 7826 COOPER RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45242-7619
Country : US
Telephone Number : 513-984-1000
Fax Number : 513-985-2182
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2007
Last Update Date : 07/08/2007

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