Organization
MARTA BANEGAS, M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTA BANEGAS M.D. (PRESIDENT)
(773) 767-8283
Entity
Organization
Contact information
Practice address
917 N LA SALLE DR, CHICAGO, IL 60610-3204
(773) 767-8283
Mailing address
PO BOX 388320, CHICAGO, IL 60638-8320
(776) 767-4600
(773) 767-4600
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1618837
BLUE SHIELD
IL
Enumeration date
07/21/2006
Last updated
08/22/2020
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