Healthcare Provider Details

I. General information

NPI: 1205459005
Provider Name (Legal Business Name): GARRET LOGAN KAHLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 PROGRESS DR STE 145&180
LANSING KS
66043-6326
US

IV. Provider business mailing address

800 RAVENHILL DR
ATCHISON KS
66002-9204
US

V. Phone/Fax

Practice location:
  • Phone: 913-297-3215
  • Fax: 913-297-2732
Mailing address:
  • Phone: 913-367-2131
  • Fax: 913-674-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-47588
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: