Provider Demographics
NPI:1497834139
Name:LOGAN GENERAL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:LOGAN GENERAL MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-384-2445
Mailing Address - Street 1:2734 N MILWAUKEE AVE
Mailing Address - Street 2:150
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1362
Mailing Address - Country:US
Mailing Address - Phone:773-384-2445
Mailing Address - Fax:773-384-1155
Practice Address - Street 1:2734 N MILWAUKEE AVE
Practice Address - Street 2:150
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1362
Practice Address - Country:US
Practice Address - Phone:773-384-2445
Practice Address - Fax:773-384-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1768840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty