Healthcare Provider Details

I. General information

NPI: 1437711975
Provider Name (Legal Business Name): MADEEHA BANU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2019
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 GREEN BAY RD
NORTH CHICAGO IL
60064-3037
US

IV. Provider business mailing address

6123 N RICHMOND ST APT 1
CHICAGO IL
60659-3163
US

V. Phone/Fax

Practice location:
  • Phone: 847-578-3227
  • Fax:
Mailing address:
  • Phone: 404-494-6132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.161381
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036.161381
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: