Healthcare Provider Details

I. General information

NPI: 1447412366
Provider Name (Legal Business Name): CHRISTABELLE ANDREA B CABANILLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTABELL ANDREA BERNARDO MD

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W 63RD ST
CHICAGO IL
60621-1902
US

IV. Provider business mailing address

PO BOX 746715
ATLANTA GA
30374-6715
US

V. Phone/Fax

Practice location:
  • Phone: 773-377-7304
  • Fax:
Mailing address:
  • Phone: 773-352-1515
  • Fax: 312-929-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2008013712
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036127298
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: