Organization
BANSA MEDICAL ASSOCIATES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EMMANUEL BANSA M.D. (OWNER)
(708) 933-0872
Entity
Organization
Contact information
Practice address
1609 SIBLEY BLVD, CALUMET CITY, IL 60409-2217
(708) 933-0872
Mailing address
1609 SIBLEY BLVD, CALUMET CITY, IL 60409-2217
(708) 933-0872
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036053245
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036053245
—
IL
Enumeration date
08/04/2017
Last updated
07/21/2022
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