Individual
MANATOSH BANERJI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
715 W NORTH AVE, MELROSE PARK, IL 60160-1612
(708) 450-4554
(708) 344-6816
Mailing address
25068 NETWORK PL, CHICAGO, IL 60673-0001
(847) 585-7000
(847) 240-0622
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
036044727
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036044727
—
IL
Enumeration date
10/19/2005
Last updated
05/02/2011
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