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1942288550 NPI number — MILA C R BACALLA MD

NPI Number: 1942288550
Health Care Provider/Practitioner: MILA C R BACALLA MD

Information about “1942288550” NPI (MILA C R BACALLA MD) exists in 1942288550 in HTML format HTML  |  1942288550 in plain Text format TXT  |  1942288550 in PDF (Portable Document Format) PDF  |  1942288550 in an XML format XML  formats.

NPI Number : 1942288550 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1942288550",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "X",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BACALLA",
    "FirstName": "MILA C",
    "MiddleName": "R",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4459 W JARVIS AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LINCOLNWOOD",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60712-1813",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "773-227-5707",
    "MailingAddressFaxNumber": "847-675-1131",
    "FirstLinePracticeLocationAddress": "2222 W DIVISION",
    "SecondLinePracticeLocationAddress": "SUITE 340",
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60622-3086",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "223-227-5707",
    "PracticeLocationAddressFaxNumber": "847-675-1131",
    "EnumerationDate": "01/04/2006",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207R00000X",
        "TaxonomyName": "Internal Medicine Physician",
        "LicenseNumber": "3647298",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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