Provider Demographics
NPI:1538912175
Name:LOGAN, LAMONT SCOTT
Entity type:Individual
Prefix:
First Name:LAMONT
Middle Name:SCOTT
Last Name:LOGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14853 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-3040
Mailing Address - Country:US
Mailing Address - Phone:313-318-4055
Mailing Address - Fax:
Practice Address - Street 1:14853 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-3040
Practice Address - Country:US
Practice Address - Phone:313-318-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health