Provider Demographics
NPI:1922280296
Name:ML MEDICAL SERVICES CORPORATION
Entity Type:Organization
Organization Name:ML MEDICAL SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LABAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-652-5423
Mailing Address - Street 1:5535 W CERMAK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-2218
Mailing Address - Country:US
Mailing Address - Phone:708-652-5423
Mailing Address - Fax:708-652-5424
Practice Address - Street 1:5535 W CERMAK RD
Practice Address - Street 2:SUITE B
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2218
Practice Address - Country:US
Practice Address - Phone:708-652-5423
Practice Address - Fax:708-652-5424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336040596 (36077467)261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1635391OtherBLUE CROSS BLUE SHIELD
IL036077467Medicaid
IL036077467Medicaid