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General NPI Number Information
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NPI Number | 1427264456
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Entity Type | Organization
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Legal Business Name | PANDELIS BANIAS, M.D., S.C.
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 800 AUSTIN ST EAST TOWER, SUITE 369
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City | EVANSTON
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State | IL
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Zip | 60202-3439
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Country | US
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Telephone | 847-316-4455
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Fax | 847-316-4456
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Provider Business Mailing Address
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Address Line | 800 AUSTIN ST EAST TOWER, SUITE 369
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City | EVANSTON
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State | IL
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Zip | 60202-3439
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Country | US
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Telephone | 847-316-4455
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Fax | 847-316-4456
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Authorized Official
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Title or Position | OWNER
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Name | DR. PANDELIS D BANIAS
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Credential | M.D.
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Telephone | 847-316-4455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State | IL
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