Provider Demographics
NPI:1962827824
Name:MELLERT, LOGAN THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:THOMAS
Last Name:MELLERT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 ARCH ST STE 240
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1496
Mailing Address - Country:US
Mailing Address - Phone:330-761-9930
Mailing Address - Fax:330-761-9936
Practice Address - Street 1:95 ARCH ST STE 240
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1496
Practice Address - Country:US
Practice Address - Phone:330-761-9930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.012012208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery