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Logan Carl Mendez

Surgery

Allopathic & Osteopathic Physicians

600 S Paulina St, Chicago, IL 60612-3806

PECOS Enrollment

This provider is enrolled in PECOS as LOGAN MENDEZ.

Based on the most recent information from CMS, provider Logan Carl Mendez is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1184373581
Provider Type
Individual
Full Name
Mendez, Logan Carl
Gender
Male

Sole Proprietor
No
Enumeration Date
3/22/2022
Last Updated
6/11/2022

Contact Information

Practice Location

600 S Paulina St, Chicago, IL 60612-3806

(312) 942-5000

Unlisted Fax

Mailing Location

600 S Paulina St, Chicago, IL 60612-3806

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 208600000X Primary	Description Surgery Allopathic & Osteopathic Physicians	License 125.079883 Illinois
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Logan Carl Mendez

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Sun, Ziyi

Lester, Erica

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Altimari, Marc

Yedidag, Emre N.

Schlanser, Victoria Lyn

Flores, Roberto Jesus

Rabin, Erik Elias

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