MEDICARE: BANIO P KOROMA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	036-069938	IL
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	036-069938	IL
3	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	01048271A	IN

General Provider Information

NPI Number	:	1962443739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BANIO P KOROMA MD

Provider Business Mailing Address
First Line	:	3319 N ELSTON AVE
Second Line	:	SUITE 100
City	:	CHICAGO
State	:	IL
Zip	:	60618-5811
Country	:	US
Telephone Number	:	773-751-7200
Fax Number	:	773-583-4295

Provider Business Practice Location Address
First Line	:	3319 N ELSTON AVE
Second Line	:	SUITE 100
City	:	CHICAGO
State	:	IL
Zip	:	60618-5811
Country	:	US
Telephone Number	:	773-751-7200
Fax Number	:	773-583-4295

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	05/08/2013

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Directions to “ BANIO P KOROMA MD” Practice Location

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