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General NPI Number Information
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NPI Number | 1497834139
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Entity Type | Organization
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Legal Business Name | LOGAN GENERAL MEDICAL CENTER INC
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2734 N MILWAUKEE AVE 150
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City | CHICAGO
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State | IL
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Zip | 60647-1362
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Country | US
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Telephone | 773-384-2445
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Fax | 773-384-1155
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Provider Business Mailing Address
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Address Line | 2734 N MILWAUKEE AVE 150
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City | CHICAGO
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State | IL
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Zip | 60647-1362
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Country | US
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Telephone | 773-384-2445
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Fax | 773-384-1155
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROSANGEL PEREZ
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Credential |
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Telephone | 773-384-2445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1768840
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License Number State | IL
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