DataLabs

datalabs.health made in the usa

Contact us Sign in | Documentation |

divider

Medicare/Medicaid Verification Programs divider

divider

Medicare Verification Program divider

divider

1720077407

NPI Code Detail

MEDICARE: MARK LOGAN M.D.

MEDICARE: MARK 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
1	207Y00000X	Otolaryngology Physician	32870	KY
2	207Y00000X	Otolaryngology Physician	01046534A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	040003023	OTHER	KY	RR MEDICARE
5	P00076697	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000045660	OTHER	KY	ANTHEM
2	000000045660	OTHER	IN	ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	064945	OTHER	IN	HEALTH ALLIANCE
8	394258	OTHER	IN	HEALTHLINK

General Provider Information

NPI Number	:	1720077407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK LOGAN M.D.

Provider Business Mailing Address
First Line	:	1401 PROFESSIONAL BLVD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-8014
Country	:	US
Telephone Number	:	812-473-2060
Fax Number	:	812-473-0763

Provider Business Practice Location Address
First Line	:	1401 PROFESSIONAL BLVD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-8014
Country	:	US
Telephone Number	:	812-473-2060
Fax Number	:	812-473-0763

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	06/30/2025

Similar Medicare Providers

1790179026 — PATRICIA A. KAWAOKA PATTERSON AUD.
Practice Location Address:

1401 PROFESSIONAL BLVD
EVANSVILLE, IN
47714-8014

Practice Phone: 812-473-2060
Practice Fax: 812-476-5118

1225980881 — OLIVIA STRATMAN
Practice Location Address:

1401 PROFESSIONAL BLVD
EVANSVILLE, IN
47714-8014

Practice Phone: 812-473-2060
Practice Fax:

1437153285 — MIDWEST EAR NOSE AND THROAT SURGERY, PSC
Practice Location Address:

1401 PROFESSIONAL BLVD
EVANSVILLE, IN
47714-8014

Practice Phone: 812-473-2060
Practice Fax: 812-473-0763

1023235090 — MRS. ROBERTA E. HOEBEKE FNP-BC
Practice Location Address:

1401 PROFESSIONAL BLVD , SUITE 100
EVANSVILLE, IN
47714-8014

Practice Phone: 812-471-4110
Practice Fax: 812-471-4275

1699973529 — DR. YOUNG SIN PAIK M.D.
Practice Location Address:

1401 PROFESSIONAL BLVD
EVANSVILLE, IN
47714-8014

Practice Phone: 812-473-2060
Practice Fax: 812-473-0763

1023273810 — DR. RYAN CHARLES PALMER D.O.
Practice Location Address:

1401 PROFESSIONAL BLVD
EVANSVILLE, IN
47714-8014

Practice Phone: 812-473-2060
Practice Fax:

Directions to “ MARK LOGAN M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.