Organization
DRS. BANUCHI AND BANUCHI, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SIRIRAT BANUCHI M.D. (PRESIDENT)
(773) 545-3123
Entity
Organization
Contact information
Practice address
4849 N MILWAUKEE AVE, SUITE 203, CHICAGO, IL 60630-5100
(773) 545-3123
(773) 545-3886
Mailing address
4849 N MILWAUKEE AVE, SUITE 203, CHICAGO, IL 60630-5100
(773) 545-3123
(773) 545-3886
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0360468271
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1615456
BLUE SHIELD
IL
Enumeration date
08/10/2006
Last updated
10/30/2007
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