Provider Demographics
NPI:1447412366
Name:CABANILLA, CHRISTABELLE ANDREA B (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTABELLE ANDREA
Middle Name:B
Last Name:CABANILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTABELL ANDREA
Other - Middle Name:
Other - Last Name:BERNARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1111 SUPERIOR ST
Mailing Address - Street 2:101
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-4138
Mailing Address - Country:US
Mailing Address - Phone:708-406-3040
Mailing Address - Fax:708-406-3059
Practice Address - Street 1:1111 SUPERIOR ST
Practice Address - Street 2:101
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4138
Practice Address - Country:US
Practice Address - Phone:708-406-3040
Practice Address - Fax:708-406-3059
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008013712207Q00000X
IL036127298207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine