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General NPI Number Information
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NPI Number | 1942288550
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Entity Type | Individual
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Provider Name | MILA C R BACALLA MD
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Gender | Female
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2222 W DIVISION SUITE 340
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City | CHICAGO
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State | IL
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Zip | 60622-3086
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Country | US
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Telephone | 223-227-5707
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Fax | 847-675-1131
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Provider Business Mailing Address
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Address Line | 4459 W JARVIS AVE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-1813
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Country | US
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Telephone | 773-227-5707
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Fax | 847-675-1131
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 3647298
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License Number State | IL
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