Organization
WESTERN DUPAGE OBSTETRICS & GYNECOLOGY SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE A BANUELOS MD (MEDICAL DOCTOR/PRESIDENT)
(630) 810-0777
Entity
Organization
Contact information
Practice address
3540 SEVEN BRIDGES DR STE 200, WOODRIDGE, IL 60517-1222
(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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2201686
BCBS ILLINOIS PROVIDER #
IL
Enumeration date
01/24/2007
Last updated
12/20/2021
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