Individual
MRS. MARY KATHERINE BISAGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
4700 W 95TH ST, SUITE 303, OAK LAWN, IL 60453-2533
(708) 857-7230
(708) 425-5779
Mailing address
4700 W 95TH ST, OAK LAWN, IL 60453-2533
(708) 857-7230
(708) 425-5779
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0091640661
BCBS
IL
01
—
0091640664
BCBSIL
IL
Enumeration date
12/12/2006
Last updated
07/08/2007
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