Individual
KUSHAL BIKRAM BANIYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4646 N MARINE DR STE 7100, CHICAGO, IL 60640-5759
(773) 564-5225
(773) 564-5226
Mailing address
5917 INVERNESS DR, FARMINGTON, NM 87402-8704
(773) 437-7028
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
125078419
IL
Other
Enumeration date
06/09/2021
Last updated
06/09/2021
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