Individual
GEORGE A BANUELOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3540 SEVEN BRIDGES DR STE 200, WOODRIDGE, IL 60517
(630) 810-0777
(630) 810-0395
Mailing address
3540 SEVEN BRIDGES DR STE 200, WOODRIDGE, IL 60517-1222
(630) 810-0777
(630) 810-0395
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036070501
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036070501
STATE LICENSE NUMBER
IL
05
—
036070501
—
IL
01
—
2201686
BCBS IL
IL
Enumeration date
11/08/2006
Last updated
12/20/2021
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