Logue, Michael Stephen

Logue, Michael Stephen is an individual health care provider with primary practice located at 10012 Kennerly Road Suite # 301, St Louis MO 63128. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Logue, Michael Stephen can be contacted via phone (314) 894-0787.

Contact Information

Primary practice address
10012 Kennerly Road Suite # 301 St Louis MO 63128
Phone: (314) 894-0787
Fax: (314) 729-1489
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 135879 Missouri
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 209004468 Illinois

Profile Details

NPI number 1750338919
LBN Legal business name Logue, Michael Stephen
Credentials FAM NRS PRAC FNP
Entity Individual
Sole proprietor 1 No
Enumeration date May 30th, 2006
Last updated Nov 7th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750338919 NPPES
Missouri Other 652432 HEALTHLINK
Missouri MEDICAID 429176605 HEALTHLINK
Missouri Other 46286 HEALTHLINK
Missouri Other 189482 HEALTHLINK
Missouri Other 7196539 HEALTHLINK
Missouri Other P00117390 HEALTHLINK
Missouri Other 072289 HEALTHLINK
Missouri MEDICAID 356650631001 HEALTHLINK

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