Provider Demographics
NPI:1679069074
Name:LOGE, CARL V (CONTRACTOR)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:V
Last Name:LOGE
Suffix:
Gender:M
Credentials:CONTRACTOR
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5126
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5126
Mailing Address - Country:US
Mailing Address - Phone:605-271-5947
Mailing Address - Fax:605-271-5997
Practice Address - Street 1:3904 W TECHNOLOGY CIR
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-4235
Practice Address - Country:US
Practice Address - Phone:605-271-5947
Practice Address - Fax:605-271-5997
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications