Provider Demographics
NPI:1417657768
Name:AIRAPETOV, GARRY
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:
Last Name:AIRAPETOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 THOMPSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1018
Mailing Address - Country:US
Mailing Address - Phone:847-221-5877
Mailing Address - Fax:847-221-5876
Practice Address - Street 1:1151 MCHENRY RD # 232
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1376
Practice Address - Country:US
Practice Address - Phone:847-221-5877
Practice Address - Fax:847-221-5876
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies