Healthcare Provider Details

I. General information

NPI: 1588379473
Provider Name (Legal Business Name): AMRITRAJ LOGANATHAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E MICHIGAN AVE
JACKSON MI
49202-3518
US

IV. Provider business mailing address

956 COOPER ST
JACKSON MI
49202-3398
US

V. Phone/Fax

Practice location:
  • Phone: 517-314-2990
  • Fax: 517-314-2991
Mailing address:
  • Phone: 517-787-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: AMRITRAJ LOGANATHAN
Title or Position: OWNER
Credential: MD
Phone: 517-787-3900