Individual
LOGAN MICHAEL RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Credential
BC-HIS
Contact information
Practice address
8726 RAMSEY DR, THEODORE, AL 36582-7040
(732) 503-2347
Mailing address
8726 RAMSEY DR, THEODORE, AL 36582-7040
(732) 503-2347
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
4241
AL
237700000X
Hearing Instrument Specialist
714
MS
Other
Enumeration date
11/21/2025
Last updated
11/21/2025
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