Organization
GUSTAVO M. BANTI, M.D., LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GUSTAVO MIGUEL BANTI M.D. (PRESIDENT)
(630) 377-1368
Entity
Organization
Contact information
Practice address
302 RANDALL RD, SUITE 306, GENEVA, IL 60134-4209
(630) 377-1368
(630) 377-7514
Mailing address
302 RANDALL RD, SUITE 306, GENEVA, IL 60134-4209
(630) 377-1368
(630) 377-7514
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036063412
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036063412
—
IL
01
—
4500628
BCBS
IL
Enumeration date
03/07/2007
Last updated
02/08/2011
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