Healthcare Provider Details

I. General information

NPI: 1104123546
Provider Name (Legal Business Name): ELEANOR RESANE BANZON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E 51ST ST
CHICAGO IL
60615-2400
US

IV. Provider business mailing address

PO BOX 820
NEW YORK NY
10025-0820
US

V. Phone/Fax

Practice location:
  • Phone: 312-572-2000
  • Fax:
Mailing address:
  • Phone: 917-397-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036.139820
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberC1-0010468
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: