Individual
DR. SHRUTEE BANIYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0271
(618) 529-0479
Mailing address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 529-0479
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036135422
IL
208M00000X
Hospitalist Physician
Primary
036.135422
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/23/2010
Last updated
05/14/2021
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