Healthcare Provider Details

I. General information

NPI: 1740397207
Provider Name (Legal Business Name): LOGAN A ONEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22631 GREATER MACK AVE. SUITE 100
ST CLAIR SHORES MI
48080-2055
US

IV. Provider business mailing address

22631 GREATER MACK AVE. SUITE 100
ST CLAIR SHORES MI
48080-2055
US

V. Phone/Fax

Practice location:
  • Phone: 313-885-2334
  • Fax: 313-885-9181
Mailing address:
  • Phone: 586-771-0100
  • Fax: 586-771-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number042225
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: