Provider Demographics
NPI:1003093824
Name:BANGASH, ANDLEEB S (MD)
Entity Type:Individual
Prefix:
First Name:ANDLEEB
Middle Name:S
Last Name:BANGASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1050 ELM CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5204
Mailing Address - Country:US
Mailing Address - Phone:414-350-1696
Mailing Address - Fax:
Practice Address - Street 1:901 LINCOLNWAY STE 302
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3429
Practice Address - Country:US
Practice Address - Phone:219-324-0014
Practice Address - Fax:219-324-0025
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45920207RC0000X, 207RC0001X
IN01081191A207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease