Individual
DONALD E BANICKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6426 OLD HUNTERS RUN, ROCKFORD, IL 61114-7812
(815) 633-5995
(815) 633-5995
Mailing address
6426 OLD HUNTERS RUN, ROCKFORD, IL 61114-7812
(815) 633-5995
(815) 633-5995
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
3604438
IL
Other
Enumeration date
07/18/2008
Last updated
07/18/2008
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