Individual
LOGAN THIRKILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
44200 WOODWARD AVE STE 212, PONTIAC, MI 48341-5045
(248) 332-4540
Mailing address
4073 CAMBROOK LN, WATERFORD, MI 48329-1606
(443) 939-2290
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703117225
MI
Other
Enumeration date
06/28/2024
Last updated
07/01/2024
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