Individual
IBEAWUCHI MBANU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6345 W 79TH ST, BURBANK, IL 60459-1133
(312) 609-0300
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101239124
VA
208M00000X
Hospitalist Physician
0101239124
VA
208M00000X
Hospitalist Physician
Primary
036141515
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C06778
GROUP PTAN
VA
Enumeration date
01/10/2007
Last updated
07/12/2022
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