Organization
PANDELIS BANIAS, M.D., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PANDELIS D BANIAS M.D. (OWNER)
(847) 316-4455
Entity
Organization
Contact information
Practice address
800 AUSTIN ST, EAST TOWER, SUITE 369, EVANSTON, IL 60202-3439
(847) 316-4455
(847) 316-4456
Mailing address
800 AUSTIN ST, EAST TOWER, SUITE 369, EVANSTON, IL 60202-3439
(847) 316-4455
(847) 316-4456
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01625523
INDIVIDUAL BLUE SHIELD ID
IL
Enumeration date
05/15/2007
Last updated
11/01/2007
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