Healthcare Provider Details

I. General information

NPI: 1104793801
Provider Name (Legal Business Name): LOGAN LLOYD MCCANN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 SHUMAN BLVD STE 240W
NAPERVILLE IL
60563-8113
US

IV. Provider business mailing address

888 E 66TH ST APT 312
INDIANAPOLIS IN
46220-1390
US

V. Phone/Fax

Practice location:
  • Phone: 847-843-2000
  • Fax:
Mailing address:
  • Phone: 812-598-3489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209.035836
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: