Individual
WILLIE BANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
GED
Contact information
Practice address
5921 S CARPENTER ST, CHICAGO, IL 60621-1433
(773) 456-7533
Mailing address
5921 S CARPENTER ST, CHICAGO, IL 60621-1433
(773) 456-7533
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Enumeration date
01/19/2022
Last updated
01/19/2022
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