Provider Demographics
NPI:1073638011
Name:MANALAC, JOSELITA C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSELITA
Middle Name:C
Last Name:MANALAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOSELITA
Other - Middle Name:C
Other - Last Name:YLAGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3111 W ARMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3818
Mailing Address - Country:US
Mailing Address - Phone:773-384-4933
Mailing Address - Fax:773-384-5037
Practice Address - Street 1:3109 W ARMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3818
Practice Address - Country:US
Practice Address - Phone:773-384-4933
Practice Address - Fax:773-384-5037
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036045280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1618703OtherBLUE CROSS
IL036045280Medicaid
IL471971Medicare ID - Type Unspecified
IL1618703OtherBLUE CROSS