Healthcare Provider Details

I. General information

NPI: 1306881768
Provider Name (Legal Business Name): ANNA K BANAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6033 W IRVING PARK RD
CHICAGO IL
60634-2521
US

IV. Provider business mailing address

6033 W IRVING PARK RD
CHICAGO IL
60634-2521
US

V. Phone/Fax

Practice location:
  • Phone: 773-777-4767
  • Fax: 773-777-0328
Mailing address:
  • Phone: 773-777-4767
  • Fax: 773-777-0328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036087494
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: