Healthcare Provider Details

I. General information

NPI: 1033156955
Provider Name (Legal Business Name): AGGEUS HEALTHCARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 S. RIVERSIDE PLAZA STE 19 EAST AGGEUS HEALTHCARE, P.C.
CHICAGO IL
60606-3728
US

IV. Provider business mailing address

10 S. RIVERSIDE PLAZA STE 19 EAST
CHICAGO IL
60606-3728
US

V. Phone/Fax

Practice location:
  • Phone: 773-770-0140
  • Fax: 312-277-6757
Mailing address:
  • Phone: 773-770-0140
  • Fax: 312-277-6757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number060.008927
License Number StateIL

VIII. Authorized Official

Name: DR. YEV GRAY
Title or Position: PRESIDENT/CEO
Credential: DPM
Phone: 773-770-0140