Individual
LOGAN SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3815 PELHAM ST STE 13, DEARBORN, MI 48124-3852
(313) 722-4683
(313) 241-9342
Mailing address
3815 PELHAM ST STE 13, DEARBORN, MI 48124-3852
(313) 722-4683
(313) 241-9342
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601010419
MI
Other
Enumeration date
01/19/2021
Last updated
03/21/2023
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