Healthcare Provider Details

I. General information

NPI: 1568683480
Provider Name (Legal Business Name): AER MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 W FULLERTON AVE
CHICAGO IL
60647-2915
US

IV. Provider business mailing address

2810 W FULLERTON AVE
CHICAGO IL
60647-2915
US

V. Phone/Fax

Practice location:
  • Phone: 773-342-8887
  • Fax: 773-342-6257
Mailing address:
  • Phone: 773-342-8887
  • Fax: 773-342-6257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: ALFREDO E RUMILLA, II
Title or Position: OWNER
Credential: MD
Phone: 773-342-8887