Provider Demographics
NPI:1235997248
Name:HILLEMANN, LOGAN
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:HILLEMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 HEATHER GLEN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-4241
Mailing Address - Country:US
Mailing Address - Phone:314-709-8999
Mailing Address - Fax:
Practice Address - Street 1:1300 HOSPITAL DR STE 120
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3204
Practice Address - Country:US
Practice Address - Phone:843-849-8418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant