Organization
JESSIE L MABAQUIAO MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA J RATCLIFFE (ADMINISTRATOR)
(773) 239-9600
Entity
Organization
Contact information
Practice address
855 W 103RD ST, SUITE 100, CHICAGO, IL 60643-2357
(773) 239-9600
(773) 239-9601
Mailing address
855 W 103RD ST, SUITE 100, CHICAGO, IL 60643-2357
(773) 239-9600
(773) 239-9601
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036082232
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036082232
—
IL
Enumeration date
08/21/2012
Last updated
08/23/2012
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