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: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 6TH AVE STE 210
LEAVENWORTH KS
66048-3248
US

IV. Provider business mailing address

1001 6TH AVE STE 210
LEAVENWORTH KS
66048-3248
US

V. Phone/Fax

Practice location:
  • Phone: 913-682-3920
  • Fax: 923-682-6239
Mailing address:
  • Phone: 913-682-3920
  • Fax: 913-682-6239

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: