Provider Demographics
NPI:1740397207
Name:ONEY, LOGAN A (MD)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:A
Last Name:ONEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:22631 GREATER MACK AVE.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2055
Mailing Address - Country:US
Mailing Address - Phone:586-771-0100
Mailing Address - Fax:586-771-0400
Practice Address - Street 1:22631 GREATER MACK AVE.
Practice Address - Street 2:SUITE 100
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2055
Practice Address - Country:US
Practice Address - Phone:313-885-2334
Practice Address - Fax:313-885-9181
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2018-01-30
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Provider Licenses
StateLicense IDTaxonomies
MI042225207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1350282Medicaid
MI1350282Medicaid