Provider Demographics
NPI:1750583324
Name:LIBRADA M.MANALIGOD,MD.S.C
Entity type:Organization
Organization Name:LIBRADA M.MANALIGOD,MD.S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIBRADA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANALIGOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-372-8384
Mailing Address - Street 1:104 S MICHIGAN AVE
Mailing Address - Street 2:SUITE 830
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-5902
Mailing Address - Country:US
Mailing Address - Phone:312-372-8384
Mailing Address - Fax:
Practice Address - Street 1:104 S MICHIGAN AVE
Practice Address - Street 2:SUITE 830
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-5902
Practice Address - Country:US
Practice Address - Phone:312-372-8384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL 36-048765174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL492400Medicare ID - Type Unspecified