Provider Demographics
NPI:1467416578
Name:BANE, CHRISTOPHER D (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:D
Last Name:BANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13011 S 104TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1508
Mailing Address - Country:US
Mailing Address - Phone:708-478-3600
Mailing Address - Fax:708-478-3552
Practice Address - Street 1:3231 EUCLID AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3471
Practice Address - Country:US
Practice Address - Phone:708-783-2055
Practice Address - Fax:708-783-2181
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105428207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL416810OtherMEDICARE GROUP
IL036105428Medicaid
IL236551OtherMEDICARE GROUP
IL1508810086OtherGROUP NPI
IL236550OtherMEDICARE GROUP
ILCD8033OtherRAILROAD MEDICARE GROUP PTAN NUMBER
IL01621208OtherBLUECROSS BLUE SHIELD
ILP00319870OtherMEDICARE RAILROAD COOK
IL236550OtherMEDICARE GROUP
ILK27758Medicare ID - Type Unspecified
I52461Medicare UPIN
ILCD8033OtherRAILROAD MEDICARE GROUP PTAN NUMBER