person
Mr. Michael Stephen Logue, FAMNRSPRACFNP
Family Nurse Practitioner in St Louis, Missouri
NPI 1750338919

Michael Stephen Logue is a Family Nurse Practitioner based in St Louis, MO and is specialized in Family. Michael Stephen Logue practices in St Louis, MO and has the professional credentials of FAMNRSPRACFNP. The NPI Number for Michael Stephen Logue is 1750338919 and holds a License No. 135879 (Missouri).

The current practice location address for Michael Stephen Logue is 10012 Kennerly Road, St Louis, MO and can be reached out via phone at 314-894-0787 and via fax at 314-729-1489. You can also correspond with Michael Stephen Logue through the mailing address at 11140 S TOWNE SQUARE, ST LOUIS, MO - 63123 (mailing address contact number: 314-894-0787).

Location: 10012 Kennerly Road, St Louis, MO, 63123
person
Provider Profile Details
NPI Number
1750338919
Provider Name
Michael Stephen Logue
Credential
FAMNRSPRACFNP
Provider Entity Type
Individual
Gender
Male
Address
10012 Kennerly Road, St Louis, MO, 63123
Phone Number
314-894-0787
Fax Number
314-729-1489
Provider Enumeration Date
05/30/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
652432 01 MO HEALTHLINK
429176605 05 MO
46286 01 MO HEALTHCARE USA
189482 01 MO BCBS
7196539 01 MO AETNA
P00117390 01 MO MEDICARE RAILROAD
072289 01 MO EXCLUSIVE CHOICE
356650631001 05 IL
institution
Provider Business Practice Location Address Details
Address
10012 Kennerly Road
City
State
Zip
63128
Phone Number
314-894-0787
Fax Number
314-729-1489
person
Provider Business Mailing Address Details
Address
11140 S Towne Square
City
State
Zip
63123
Phone Number
314-894-0787
Fax Number
314-729-3963
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
License No.
135879 (Missouri)
Definition
Definition to come...
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