MEDICARE: AROGYA AESTHETICS AND WELLNESS

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	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L52079874779	OTHER	IL	DRIVERS LICENSE

General Provider Information

NPI Number	:	1720685779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AROGYA AESTHETICS AND WELLNESS

Provider Business Mailing Address
First Line	:	4743 N CLARK ST STE 1S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-7020
Country	:	US
Telephone Number	:	312-550-7366
Fax Number	:	510-275-0489

Provider Business Practice Location Address
First Line	:	4743 N CLARK ST STE 1S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-7020
Country	:	US
Telephone Number	:	312-550-7366
Fax Number	:	510-275-0489

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. SHIREEN LONG
Credential	:	APRN
Telephone Number	:	847-791-7654

Provider Enumeration Date	:	10/02/2020
Last Update Date	:	03/11/2026

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