Provider Demographics
NPI:1598842064
Name:BANCHS, RICHARD J (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:BANCHS
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 1:2108 N KARLOV AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-3716
Mailing Address - Country:US
Mailing Address - Phone:716-866-4619
Mailing Address - Fax:
Practice Address - Street 1:1740 WEST TAYLOR STREET, SUITE 3200 WEST
Practice Address - Street 2:UNIVERSITY OF ILLINOIS MED CTR, DEPT ANESTHESIA MC 515
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7239
Practice Address - Country:US
Practice Address - Phone:716-866-4619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44907207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN089209200Medicaid
MN089209200Medicaid
MN050001534Medicare ID - Type Unspecified