# LOGAN MULTISPECIALTY CLINIC S C

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770015836
- **Authorized official:** DR. FACUNDO BENITO DOVALE M.D. (DIRECTOR)
- **Authorized official phone:** (630) 532-2021

## Contact information

- **Practice address:** 15W560 91ST ST, BURR RIDGE, IL 60527-6365
- **Practice address phone:** (630) 532-2021
- **Practice address fax:** (630) 655-1815
- **Mailing address:** 15W560 91ST ST, BURR RIDGE, IL 60527-6365
- **Mailing address phone:** (630) 532-2021
- **Mailing address fax:** (630) 655-1815

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 036085934 | IL | Yes |

## Other

- **Enumeration date:** 03/29/2017
- **Last updated:** 03/21/2018