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General NPI Number Information
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NPI Number | 1922280296
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Entity Type | Organization
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Legal Business Name | ML MEDICAL SERVICES CORPORATION
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 5535 W CERMAK RD SUITE B
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City | CICERO
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State | IL
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Zip | 60804-2218
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Country | US
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Telephone | 708-652-5423
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Fax | 708-652-5424
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Provider Business Mailing Address
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Address Line | 5535 W CERMAK RD SUITE B
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City | CICERO
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State | IL
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Zip | 60804-2218
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Country | US
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Telephone | 708-652-5423
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Fax | 708-652-5424
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Authorized Official
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Title or Position | CEO
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Name | DR. ISRAEL LABAO
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Credential | M.D.
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Telephone | 708-652-5423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 336040596 (36077467)
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License Number State | IL
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