Provider Demographics
NPI:1821016643
Name:GREGORIO R AGLIPAY MDSC
Entity Type:Organization
Organization Name:GREGORIO R AGLIPAY MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORIO
Authorized Official - Middle Name:R
Authorized Official - Last Name:AGLIPAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-588-3293
Mailing Address - Street 1:5501 W 79TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1784
Mailing Address - Country:US
Mailing Address - Phone:773-884-4523
Mailing Address - Fax:773-884-4580
Practice Address - Street 1:5441 N SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-4622
Practice Address - Country:US
Practice Address - Phone:773-588-3293
Practice Address - Fax:773-333-5661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063008208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1632313OtherBLUE SHIELD
IL036063008Medicaid
IL202271Medicare ID - Type Unspecified
IL036063008Medicaid