MEDICARE: GREGORIO R AGLIPAY MDSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	036063008	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1632313	OTHER	IL	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821016643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORIO R AGLIPAY MDSC

Provider Business Mailing Address
First Line	:	5501 W 79TH ST
Second Line	:	SUITE 400
City	:	BURBANK
State	:	IL
Zip	:	60459-1784
Country	:	US
Telephone Number	:	773-884-4523
Fax Number	:	773-884-4580

Provider Business Practice Location Address
First Line	:	5441 N SAINT LOUIS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-4622
Country	:	US
Telephone Number	:	773-588-3293
Fax Number	:	773-333-5661

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GREGORIO R AGLIPAY
Credential	:	M.D.
Telephone Number	:	773-588-3293

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	12/15/2014

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