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General NPI Number Information
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NPI Number | 1699377200
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Entity Type | Organization
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Legal Business Name | B&A HEALTH PROVIDER LLC
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Dates
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Enumeration Date | 11/10/2020
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 1450 PLAINFIELD RD STE 5
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City | DARIEN
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State | IL
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Zip | 60561-5944
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Country | US
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Telephone | 708-846-4972
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Fax |
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Provider Business Mailing Address
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Address Line | 507 W WALNUT AVE
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City | DES PLAINES
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State | IL
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Zip | 60016-5817
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Country | US
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Telephone | 224-251-8149
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANNALIZA S TEANO
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Credential |
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Telephone | 708-846-4972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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