Individual
ISRAEL DISAMALA LABAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5535 W. CERMAK RD, SUITE B, CICERO, IL 60804-2218
(708) 652-5423
(708) 652-5424
Mailing address
5535 W. CERMAK RD, SUITE B, CICERO, IL 60804-2218
(708) 652-5423
(708) 652-5424
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036077467
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1635391
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/09/2005
Last updated
10/09/2012
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