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General NPI Number Information
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NPI Number | 1992068829
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Entity Type | Individual
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Provider Name | LOGAN CAMPBELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 2333 BIDDLE AVE
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City | WYANDOTTE
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State | MI
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Zip | 48192-4668
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Country | US
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Telephone | 734-246-6039
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Fax |
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Provider Business Mailing Address
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Address Line | 6600 S YALE AVE STE 1200
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City | TULSA
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State | OK
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Zip | 74136-3361
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Country | US
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Telephone | 918-488-6045
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Fax | 918-488-6098
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 33940
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 4301511864
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License Number State | MI
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