Provider Demographics
NPI:1518308600
Name:ASB MEDICAL CLINIC, LTD
Entity Type:Organization
Organization Name:ASB MEDICAL CLINIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BANAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-777-4767
Mailing Address - Street 1:6033 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2521
Mailing Address - Country:US
Mailing Address - Phone:773-777-4767
Mailing Address - Fax:773-777-0328
Practice Address - Street 1:6033 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2521
Practice Address - Country:US
Practice Address - Phone:773-777-4767
Practice Address - Fax:773-777-0328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36087494208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty