Logan Tyler Garthe, MD
Family Medicine in Springfield, IL. Individual provider (NPI-1).
NPI number1962025577
StatusActive
Last updated in NPPESJul 11, 2020
Details
- NPI
- 1962025577
- Entity type
- Individual (NPI-1)
- Name
- Logan Tyler Garthe
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 19, 2020
- Certification date
- Jul 11, 2020
- Last updated
- Jul 11, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 125.076610 | IL | Yes |
Practice location
520 N 4th StSpringfield, IL 62702-5238
Phone 618-406-6011
Mailing address
Po Box 19670Springfield, IL 62794-9670
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