Provider Demographics
NPI:1720685779
Name:AROGYA GLO MEDCLINIC
Entity Type:Organization
Organization Name:AROGYA GLO MEDCLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:847-791-7654
Mailing Address - Street 1:6524 HOFFMAN TER
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-1414
Mailing Address - Country:US
Mailing Address - Phone:847-791-7654
Mailing Address - Fax:
Practice Address - Street 1:2909 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2004
Practice Address - Country:US
Practice Address - Phone:312-572-9077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL52079874779OtherDRIVERS LICENSE