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General NPI Number Information
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NPI Number | 1104710151
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Entity Type | Organization
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Legal Business Name | OCTAVE HEALHCARE CORP
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 1431 N WESTERN AVE STE 209
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City | CHICAGO
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State | IL
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Zip | 60622-7712
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Country | US
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Telephone | 630-460-7715
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Fax |
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Provider Business Mailing Address
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Address Line | 1S376 SUMMIT AVE STE 4C
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City | OAKBROOK TERRACE
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State | IL
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Zip | 60181-3966
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Country | US
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Telephone | 630-424-1122
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Fax | 630-324-0067
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Authorized Official
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Title or Position | OWNER
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Name | VALERIE MAYUGA
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Credential | MD
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Telephone | 773-772-7854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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