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Organization
LOGAN PRIMARY CARE
Active
Organization
LOGAN PRIMARY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICAH OAKLEY PA-C (PHYSICIAN ASSISTANT)
(618) 993-3300
Entity
Organization
Contact information
Practice address
405 RUSHING DR, HERRIN, IL 62948-3730
(618) 993-3300
(618) 993-0262
Mailing address
405 RUSHING DR, HERRIN, IL 62948-3730
(618) 993-3300
(618) 993-0262
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085-003043
IL
Other
Enumeration date
08/07/2008
Last updated
08/07/2008
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