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1204 S 57th Ave Cicero IL 60804-1148 | |
| (312) 375-7145 | |
| (708) 652-5424 |
| Full Name | |
|---|---|
| Speciality | Family Medicine - Geriatric Medicine |
| Location | 1204 S 57th Ave, Cicero, Illinois |
| Authorized Official Name and Position | Divinegrace Labao (OWNER/PRESIDENT) |
| Authorized Official Contact | 3123757145 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1204 S 57th Ave Cicero IL 60804-1148 Ph: (312) 375-7145 | 1204 S 57th Ave Cicero IL 60804-1148 Ph: (312) 375-7145 |
| NPI Number | 1073807707 |
|---|---|
| Provider Enumeration Date | 05/28/2011 |
| Last Update Date | 05/28/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073807707 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
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