Provider Demographics
NPI:1104710151
Name:OCTAVE HEALHCARE CORP
Entity type:Organization
Organization Name:OCTAVE HEALHCARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYUGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-772-7854
Mailing Address - Street 1:1S376 SUMMIT AVE STE 4C
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3966
Mailing Address - Country:US
Mailing Address - Phone:630-424-1122
Mailing Address - Fax:630-324-0067
Practice Address - Street 1:1431 N WESTERN AVE STE 209
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-7712
Practice Address - Country:US
Practice Address - Phone:630-460-7715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty