Healthcare Provider Details

I. General information

NPI: 1114292026
Provider Name (Legal Business Name): AUM GURU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MCDONOUGH RD STE 209
HOFFMAN ESTATES IL
60192-4566
US

IV. Provider business mailing address

6785 WEAVER RD STE D
ROCKFORD IL
61114-8055
US

V. Phone/Fax

Practice location:
  • Phone: 224-238-3816
  • Fax:
Mailing address:
  • Phone: 815-633-8586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number036117242
License Number StateIL

VIII. Authorized Official

Name: DHAVAL PATEL
Title or Position: MANAGER
Credential: MD
Phone: 224-238-3816