Individual ProviderLogan LewPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1620 W Harrison St, Chicago, IL 60612-3801(312) 942-4200PECOS EnrollmentBased on the most recent information from CMS, provider Logan Lew is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1093541021Provider TypeIndividualFull NameLew, LoganGenderMaleSole ProprietorNoEnumeration Date9/9/2024Last Updated9/9/2024Contact InformationPractice LocationPractice Address1620 W Harrison St, Chicago, IL 60612-3801Phone(312) 942-4200FaxUnlisted FaxMailing LocationMailing Address1620 W Harrison St, Chicago, IL 60612-3801PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted Issuer