Healthcare Provider Details

I. General information

NPI: 1811948243
Provider Name (Legal Business Name): VINCENT F BIANK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CENTRAL ST STE 800
EVANSTON IL
60201-1780
US

IV. Provider business mailing address

1000 CENTRAL ST STE HOSPITAL
EVANSTON IL
60201-1777
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-1795
  • Fax: 847-503-4590
Mailing address:
  • Phone: 847-570-1795
  • Fax: 847-503-4590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036129342
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080T0004X
TaxonomyPediatric Transplant Hepatology Physician
License Number036129342
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number036129342
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: