Healthcare Provider Details

I. General information

NPI: 1821016643
Provider Name (Legal Business Name): GREGORIO R AGLIPAY MDSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5441 N SAINT LOUIS AVE
CHICAGO IL
60625-4622
US

IV. Provider business mailing address

5501 W 79TH ST SUITE 400
BURBANK IL
60459-1784
US

V. Phone/Fax

Practice location:
  • Phone: 773-588-3293
  • Fax: 773-333-5661
Mailing address:
  • Phone: 773-884-4523
  • Fax: 773-884-4580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036063008
License Number StateIL

VIII. Authorized Official

Name: GREGORIO R AGLIPAY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 773-588-3293