NPIMap

Organization Active NPI

Logan Multispecialty Clinic S C

  • Internal Medicine Physician
  • Burr Ridge, IL
National Provider Identifier
1770015836
Registry record updated Mar 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036085934 Issued in IL
Legal business name
LOGAN MULTISPECIALTY CLINIC S C
Practice address
15W560 91St St
Burr Ridge, IL 60527-6365
Phone
(630) 532-2021
Fax
(630) 655-1815
NPI assigned
Mar 29, 2017
Last updated
Mar 21, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Facundo Benito Dovale, M.D.
Title
Director
Phone
(630) 532-2021

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 036085934 IL Primary

Addresses

Primary practice location

15W560 91St St
Burr Ridge, IL 60527-6365

Mailing address

15W560 91St St
Burr Ridge, IL 60527-6365
Phone (630) 532-2021

Other identifiers 1

IdentifierTypeStateIssuer
20150720620350MedicaidIL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521590400000",
    "number": "1770015836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15W560 91ST ST",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276365",
            "telephone_number": "630-532-2021",
            "fax_number": "630-655-1815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15W560 91ST ST",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276365",
            "telephone_number": "630-532-2021",
            "fax_number": "630-655-1815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGAN MULTISPECIALTY CLINIC S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-29",
        "last_updated": "2018-03-21",
        "status": "A",
        "authorized_official_last_name": "DOVALE",
        "authorized_official_first_name": "FACUNDO",
        "authorized_official_middle_name": "BENITO",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "630-532-2021",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036085934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20150720620350",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burr Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.