Individual
LOGAN C HUBBARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2945 HAZELWOOD ST STE 200, MAPLEWOOD, MN 55109-1243
(651) 232-7800
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
4301508586
MI
390200000X
Student in an Organized Health Care Education/Training Program
390200000X
—
Other
Enumeration date
04/30/2018
Last updated
05/17/2024
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