Individual
JACOB LOGAN GUIMOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
22250 PROVIDENCE DR STE 700, SOUTHFIELD, MI 48075-6215
(248) 849-3401
(248) 849-4106
Mailing address
22250 PROVIDENCE DR STE 700, SOUTHFIELD, MI 48075-6215
(248) 849-3401
(248) 849-4106
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
5151017915
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/26/2024
Last updated
04/16/2026
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