# PANDELIS BANIAS, M.D., S.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427264456
- **Authorized official:** DR. PANDELIS D BANIAS M.D. (OWNER)
- **Authorized official phone:** (847) 316-4455

## Contact information

- **Practice address:** 800 AUSTIN ST, EAST TOWER, SUITE 369, EVANSTON, IL 60202-3439
- **Practice address phone:** (847) 316-4455
- **Practice address fax:** (847) 316-4456
- **Mailing address:** 800 AUSTIN ST, EAST TOWER, SUITE 369, EVANSTON, IL 60202-3439
- **Mailing address phone:** (847) 316-4455
- **Mailing address fax:** (847) 316-4456

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | IL | Yes |

## Other

- **Enumeration date:** 05/15/2007
- **Last updated:** 11/01/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01625523 | INDIVIDUAL BLUE SHIELD ID | IL |