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NPI Code Detail

MEDICARE: SIERRA LOGAN

MEDICARE: SIERRA LOGAN
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1033970264
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIERRA LOGAN
Provider Business Mailing Address
First Line : 630 LEBARON AVE
Second Line :
City : PONTIAC
State : MI
Zip : 48340-3010
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2399 E WALTON BLVD
Second Line :
City : AUBURN HILLS
State : MI
Zip : 48326-1955
Country : US
Telephone Number : 248-475-6300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2024
Last Update Date : 01/16/2024

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Directions to “ SIERRA LOGAN ” Practice Location

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