Individual
DENICE MARIE LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
80 68TH ST SE, GRAND RAPIDS, MI 49548-6980
(616) 391-8242
(616) 391-8317
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
(616) 391-8242
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5101008223
MI
2083X0100X
Occupational Medicine Physician
5101008223
MI
Other
Enumeration date
10/19/2006
Last updated
05/06/2014
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