Provider Demographics
NPI:1588379473
Name:AMRITRAJ LOGANATHAN MD PC
Entity type:Organization
Organization Name:AMRITRAJ LOGANATHAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMRITRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGANATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-787-3900
Mailing Address - Street 1:956 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3398
Mailing Address - Country:US
Mailing Address - Phone:517-787-3900
Mailing Address - Fax:
Practice Address - Street 1:1400 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3518
Practice Address - Country:US
Practice Address - Phone:517-314-2990
Practice Address - Fax:517-314-2991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty