Individual
DR. CHARLOTTE A LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4201 SAINT ANTOINE ST, DETROIT, MI 48201-2153
(313) 745-3000
Mailing address
18461 WOODINGHAM DR, DETROIT, MI 48221-2155
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD438501
PA
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
4301070300
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104205730
—
MI
05
—
104205740
—
MI
05
—
104317183
—
MI
05
—
104649020
—
MI
05
—
1891756243
—
IA
01
—
CL070300
BC/BS OF MI
MI
Enumeration date
03/28/2006
Last updated
08/22/2019
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