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General NPI Number Information
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NPI Number | 1033156955
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Entity Type | Organization
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Legal Business Name | AGGEUS HEALTHCARE, P.C.
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 08/31/2012
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Provider Practice Location Address
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Address Line | 10 S. RIVERSIDE PLAZA STE 19 EAST AGGEUS HEALTHCARE, P.C.
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City | CHICAGO
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State | IL
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Zip | 60606-3728
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Country | US
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Telephone | 773-770-0140
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Fax | 312-277-6757
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Provider Business Mailing Address
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Address Line | 10 S. RIVERSIDE PLAZA STE 19 EAST
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City | CHICAGO
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State | IL
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Zip | 60606-3728
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Country | US
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Telephone | 773-770-0140
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Fax | 312-277-6757
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. YEV GRAY
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Credential | DPM
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Telephone | 773-770-0140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 060.008927
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License Number State | IL
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