| Logan Multispecialty Clinic S C | |
|
15w560 91st St Burr Ridge IL 60527-6365 | |
| (630) 532-2021 | |
| (630) 655-1815 |
| Full Name | Logan Multispecialty Clinic S C |
|---|---|
| Speciality | Internal Medicine |
| Location | 15w560 91st St, Burr Ridge, Illinois |
| Authorized Official Name and Position | Facundo Benito Dovale (DIRECTOR) |
| Authorized Official Contact | 6305322021 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Logan Multispecialty Clinic S C 15w560 91st St Burr Ridge IL 60527-6365 Ph: (630) 532-2021 | Logan Multispecialty Clinic S C 15w560 91st St Burr Ridge IL 60527-6365 Ph: (630) 532-2021 |
| NPI Number | 1770015836 |
|---|---|
| Provider Enumeration Date | 03/29/2017 |
| Last Update Date | 03/21/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770015836 | NPI | - | NPPES |
| 20150720620350 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036085934 (Illinois) | Primary |
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