Provider Demographics
NPI:1033156955
Name:AGGEUS HEALTHCARE, P.C.
Entity Type:Organization
Organization Name:AGGEUS HEALTHCARE, P.C.
Other - Org Name:MIDWEST PODIATRY CONSULTANTS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YEV
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-770-0140
Mailing Address - Street 1:10 S. RIVERSIDE PLAZA
Mailing Address - Street 2:STE 19 EAST
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-3728
Mailing Address - Country:US
Mailing Address - Phone:773-770-0140
Mailing Address - Fax:312-277-6757
Practice Address - Street 1:10 S. RIVERSIDE PLAZA STE 19 EAST
Practice Address - Street 2:AGGEUS HEALTHCARE, P.C.
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-3728
Practice Address - Country:US
Practice Address - Phone:773-770-0140
Practice Address - Fax:312-277-6757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060.008927213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2593804Medicaid
ILDC8690OtherRR MEDICARE
WIDC9200OtherRR MEDICARE
OKOKB5080OtherMEDICARE
IL01634862OtherBCBS
WI43267400Medicaid
MNC04991OtherMEDICARE
IL01634862OtherBCBS
ILU97210Medicare UPIN
ILU66729Medicare UPIN
IL208957Medicare ID - Type Unspecified
WI43267400Medicaid
OKOKB5080OtherMEDICARE
WIDC9200OtherRR MEDICARE
ILV04129Medicare UPIN