Provider Demographics
NPI:1710063714
Name:BANGAYAN, LORRAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:
Last Name:BANGAYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LORRAINE
Other - Middle Name:
Other - Last Name:BANGAYAN-ABIAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4606 GILBERT AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1644
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15900 CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452
Practice Address - Country:US
Practice Address - Phone:708-633-3244
Practice Address - Fax:708-633-2074
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-091169207R00000X
IL036091169207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine