| Logan Square Medical Grp | |
|
2511 N Kedzie Blvd Chicago IL 60647-2634 | |
| (773) 489-7040 | |
| (773) 489-7729 |
| Full Name | Logan Square Medical Grp |
|---|---|
| Speciality | Family Medicine |
| Location | 2511 N Kedzie Blvd, Chicago, Illinois |
| Authorized Official Name and Position | Finley Webster Brown (DOCTOR/OWNER) |
| Authorized Official Contact | 7734897040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Logan Square Medical Grp 2511 N Kedzie Blvd Chicago IL 60647-2634 Ph: (773) 489-7040 | Logan Square Medical Grp 2511 N Kedzie Blvd Chicago IL 60647-2634 Ph: (773) 489-7040 |
| NPI Number | 1427233998 |
|---|---|
| Provider Enumeration Date | 01/03/2008 |
| Last Update Date | 02/10/2016 |
| Medicare PECOS PAC ID | 7911067590 |
|---|---|
| Medicare Enrollment ID | O20081201000235 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427233998 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Finley W Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477600716 PECOS PAC ID: 2668532243 Enrollment ID: I20081201000225 |
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