Provider Demographics
NPI:1134302599
Name:LOGANATHAN, AMRITRAJ GANESH (MD)
Entity Type:Individual
Prefix:DR
First Name:AMRITRAJ
Middle Name:GANESH
Last Name:LOGANATHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1400 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3518
Mailing Address - Country:US
Mailing Address - Phone:517-314-2990
Mailing Address - Fax:517-314-2991
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
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2023-11-10
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Provider Licenses
StateLicense IDTaxonomies
NC141229207T00000X
MI4301103860207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery