Individual
LOGAN RENEE GRUBB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3132 OLD JACKSONVILLE RD STE 200, SPRINGFIELD, IL 62704-7401
(217) 862-0800
(217) 862-0871
Mailing address
3132 OLD JACKSONVILLE RD STE 200, SPRINGFIELD, IL 62704-7401
(217) 862-0800
(217) 862-0871
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036173042
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036173042
IL MD LICENSE
IL
Enumeration date
06/17/2022
Last updated
07/01/2025
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