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NPI Code Detail

MEDICARE: DR. WREN WILLOW LOGAN M.D.

MEDICARE: DR. WREN WILLOW LOGAN M.D.
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
1390200000XStudent in an Organized Health Care Education/Training Program
22084N0400XNeurology Physician036.160349IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982139705
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WREN WILLOW LOGAN M.D.
Provider Business Mailing Address
First Line : 3948 N SHERIDAN RD
Second Line :
City : CHICAGO
State : IL
Zip : 60613-2935
Country : US
Telephone Number : 773-388-1600
Fax Number : 773-388-8936
Provider Business Practice Location Address
First Line : 3948 N SHERIDAN RD
Second Line :
City : CHICAGO
State : IL
Zip : 60613-2935
Country : US
Telephone Number : 773-388-1600
Fax Number : 773-388-8936
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2017
Last Update Date : 07/05/2022

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Directions to “ DR. WREN WILLOW LOGAN M.D.” Practice Location

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