Provider Demographics
NPI:1598176836
Name:HELLAND, LOGAN (MD)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:HELLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MAYO D429, MMC 96
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-1009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:319-356-8468
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:MAYO D429, MMC 96
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-1009
Practice Address - Country:US
Practice Address - Phone:612-624-6666
Practice Address - Fax:319-356-8468
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN69335207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program