MEDICARE: AGAPE FAMILY WOUND CARE LLC

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1770362196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE FAMILY WOUND CARE LLC

Provider Business Mailing Address
First Line	:	5800 S PARK AVE
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-3021
Country	:	US
Telephone Number	:	773-983-6204
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 W DEVON AVE STE 210
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-4537
Country	:	US
Telephone Number	:	773-983-6204
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ABDUL MOGHNI
Credential	:
Telephone Number	:	773-983-6204

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	05/30/2025

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Directions to “AGAPE FAMILY WOUND CARE LLC ” Practice Location

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