MEDICARE: MONICA LOGAN MD

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	207P00000X	Emergency Medicine Physician	036.158564	IL
2	207P00000X	Emergency Medicine Physician	82391-20	WI

General Provider Information

NPI Number	:	1568923498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA LOGAN MD

Provider Business Mailing Address
First Line	:	4440 W 95TH ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2600
Country	:	US
Telephone Number	:	708-684-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	17800 KEDZIE AVE
Second Line	:
City	:	HAZEL CREST
State	:	IL
Zip	:	60429-2029
Country	:	US
Telephone Number	:	708-799-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	06/03/2026

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Directions to “ MONICA LOGAN MD” Practice Location

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