MEDICARE: FRESENIUS MEDICAL CARE LOGAN SQUARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center		IL

General Provider Information

NPI Number	:	1457690604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESENIUS MEDICAL CARE LOGAN SQUARE, LLC

Provider Business Mailing Address
First Line	:	2721 N SPAULDING AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1338
Country	:	US
Telephone Number	:	773-292-2971
Fax Number	:	773-292-2969

Provider Business Practice Location Address
First Line	:	2721 N SPAULDING AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1338
Country	:	US
Telephone Number	:	773-292-2971
Fax Number	:	773-292-2969

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	BARRY L. BLANTON
Credential	:
Telephone Number	:	781-699-9000

Provider Enumeration Date	:	02/07/2013
Last Update Date	:	10/19/2023

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