Provider Demographics
NPI:1891904249
Name:AGGEUS HEALTHCARE PC
Entity Type:Organization
Organization Name:AGGEUS HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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 1:4350 N BROADWAY ST
Mailing Address - Street 2:FL 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1781
Mailing Address - Country:US
Mailing Address - Phone:773-770-0140
Mailing Address - Fax:773-770-0141
Practice Address - Street 1:4350 N BROADWAY ST
Practice Address - Street 2:FL 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1781
Practice Address - Country:US
Practice Address - Phone:773-770-0140
Practice Address - Fax:773-770-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060008927332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5083600001Medicare NSC
WI5083600001Medicare NSC
MN5083600001Medicare NSC
IL5083600001Medicare NSC
IN5083600001Medicare NSC