Individual
DR. MARIA LOURDES GERALDINE BANAAD-OMIOTEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6201 W TOUHY AVE, CHICAGO, IL 60646-1100
(847) 673-5166
(847) 673-5636
Mailing address
6201 W TOUHY AVE, CHICAGO, IL 60646-1100
(847) 673-5166
(847) 673-5636
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036110773
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001623791
BLUE CROSS BLUE SHIELD
IL
05
—
036110773
—
IL
Enumeration date
03/07/2006
Last updated
08/04/2015
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