Organization
LOGAN MULTISPECIALTY CLINIC S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FACUNDO BENITO DOVALE M.D. (DIRECTOR)
(630) 532-2021
Entity
Organization
Contact information
Practice address
15W560 91ST ST, BURR RIDGE, IL 60527-6365
(630) 532-2021
(630) 655-1815
Mailing address
15W560 91ST ST, BURR RIDGE, IL 60527-6365
(630) 532-2021
(630) 655-1815
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036085934
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20150720620350
—
IL
Enumeration date
03/29/2017
Last updated
03/21/2018
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