Individual
BRIDGET S BANACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D. PH.D.
Contact information
Practice address
5841 S MARYLAND AVE, RM P-615 MC6101, CHICAGO, IL 60637-1447
(773) 834-7708
Mailing address
5841 S MARYLAND AVE, RM P-615 MC6101, CHICAGO, IL 60637-1447
(773) 834-7708
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
036137292
IL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
125061495
IL
Other
Enumeration date
07/01/2012
Last updated
10/17/2024
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