MEDICARE: THE GLOCOMS GROUP 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	302F00000X	Exclusive Provider Organization
2	171W00000X	Contractor

General Provider Information

NPI Number	:	1811272248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GLOCOMS GROUP INC

Provider Business Mailing Address
First Line	:	1400 W FULTON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-1110
Country	:	US
Telephone Number	:	312-456-0991
Fax Number	:	312-949-9139

Provider Business Practice Location Address
First Line	:	40 E CHICAGO AVE # 200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2026
Country	:	US
Telephone Number	:	312-456-0991
Fax Number	:	312-949-9139

Authorized Official
Title or Position	:	CHAIRMAN & CEO
Name	:	DR. MAURENCE ANGUH
Credential	:
Telephone Number	:	312-456-0991

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	10/17/2011

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