Active NPI
Kelly Logan, M.D.
- Pediatrics Physician
- Chicago, IL
National Provider Identifier
1558625244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 125062190
- Practice address
- 225 E Chicago Ave
Chicago, IL 60611-2991 - Phone
- (312) 227-4000
- NPI assigned
- Jun 27, 2012
- Last updated
- Oct 10, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 125062190 | IL | Primary |
Addresses
Primary practice location
225 E Chicago Ave
Chicago, IL 60611-2991
Mailing address
727 Colorado CT
Naperville, IL 60565-5360
Other practice location 1
1653 W Congress Pkwy
Chicago, IL 60612-3833
Phone (312) 942-5000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125062190 | IL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507593600000",
"number": "1558625244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "727 COLORADO CT",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605655360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 E CHICAGO AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606112991",
"telephone_number": "312-227-4000"
}
],
"practiceLocations": [
{
"address_1": "1653 W Congress Pkwy",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606123833",
"country_code": "US",
"telephone_number": "312-942-5000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LOGAN",
"first_name": "KELLY",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-27",
"last_updated": "2017-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "125062190",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.