Provider Demographics
NPI:1477542926
Name:BANEGAS, MARTA E (MD)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:E
Last Name:BANEGAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N HALSTED ST
Mailing Address - Street 2:SUITE# 505
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5188
Mailing Address - Country:US
Mailing Address - Phone:773-281-1044
Mailing Address - Fax:773-281-1049
Practice Address - Street 1:3000 N HALSTED ST
Practice Address - Street 2:SUITE# 505
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5188
Practice Address - Country:US
Practice Address - Phone:773-281-1044
Practice Address - Fax:773-281-1049
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360564502084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001618837OtherBLUE SHIELD
260048416OtherRAILROAD MEDICARE
IL036056450Medicaid
IL0001617631OtherIL BLUE SHIELD
C44074Medicare UPIN