Healthcare Provider Details

I. General information

NPI: 1891904249
Provider Name (Legal Business Name): AGGEUS HEALTHCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 N BROADWAY ST FL 2
CHICAGO IL
60613-1781
US

IV. Provider business mailing address

4350 N BROADWAY ST FL 2
CHICAGO IL
60613-1781
US

V. Phone/Fax

Practice location:
  • Phone: 773-770-0140
  • Fax: 773-770-0141
Mailing address:
  • Phone: 773-770-0140
  • Fax: 773-770-0141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number060008927
License Number StateIL

VIII. Authorized Official

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