Provider Demographics
NPI:1346085149
Name:DALLOW, KARAM LOGAN (MD)
Entity type:Individual
Prefix:
First Name:KARAM
Middle Name:LOGAN
Last Name:DALLOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1400
Mailing Address - Country:US
Mailing Address - Phone:618-536-6221
Mailing Address - Fax:618-453-0076
Practice Address - Street 1:300 W OAK ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1400
Practice Address - Country:US
Practice Address - Phone:618-536-6221
Practice Address - Fax:618-453-0076
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125084878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine