Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Logan Sparks, PA

Individual provider Physician Assistant · NPI 1306436845

Logan Sparks, PA is a Physician Assistant in Dearborn, Michigan. Qualified in 2020, 6 years ago. Practices with Michigan Advanced Psychiatry, PC, a 9-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Michigan.

Years since qualifying
6
Licensed in
MI
In the registry since
2021
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

3815 Pelham St Ste 13
Dearborn, MI 48124-3852
Phone: (313) 722-4683
Fax: (313) 241-9342
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601010419 (MI)

Record details

NPI number1306436845
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedJanuary 19, 2021
Last updated in NPPESMarch 21, 2023
Certification dateMarch 21, 2023
Mailing address3815 Pelham St Ste 13, Dearborn, MI 48124-3852

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Michigan Advanced Psychiatry, P.C. — 9 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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