Organization
MICHAEL J. LOGAN MD, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL JEFFREY LOGAN M.D. (OWNER/PRESIDENT)
(262) 786-1710
Entity
Organization
Contact information
Practice address
16535 W BLUEMOUND RD STE 200, BROOKFIELD, WI 53005-5906
(262) 789-0909
(262) 821-6180
Mailing address
15065 WESTOVER RD, ELM GROVE, WI 53122-1541
(262) 786-1710
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
16418-20
WI
Other
Enumeration date
11/22/2010
Last updated
11/22/2010
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