MEDICARE: AEVUM INSTITUTE FOR CELLULAR MEDICINE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1100X	Research Clinic/Center

General Provider Information

NPI Number	:	1699622126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AEVUM INSTITUTE FOR CELLULAR MEDICINE, INC.

Provider Business Mailing Address
First Line	:	3004 ORANGE GROVE, STE. 2
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820
Country	:	US
Telephone Number	:	602-885-3917
Fax Number	:

Provider Business Practice Location Address
First Line	:	3004 ORANGE GROVE, STE. 2
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820
Country	:	US
Telephone Number	:	602-885-3917
Fax Number	:

Authorized Official
Title or Position	:	CO-FOUNDER AND CEO
Name	:	DR. JAN B. TAWAKOL
Credential	:	TAWAKOL
Telephone Number	:	602-885-3917

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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