Healthcare Provider Details

I. General information

NPI: 1205094968
Provider Name (Legal Business Name): BETY CARMEN CIOBANU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT AVE STE. #400
CHICAGO IL
60631-3745
US

IV. Provider business mailing address

25070 NETWORK PL
CHICAGO IL
60673-3723
US

V. Phone/Fax

Practice location:
  • Phone: 773-763-9300
  • Fax: 773-763-1622
Mailing address:
  • Phone: 847-585-7000
  • Fax: 847-240-0622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036117375
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: