Provider Demographics
NPI:1790053940
Name:ANTONI BANAS INC
Entity Type:Organization
Organization Name:ANTONI BANAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONI
Authorized Official - Middle Name:
Authorized Official - Last Name:BANAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-932-3540
Mailing Address - Street 1:19 HERITAGE DR STE 209
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1369
Mailing Address - Country:US
Mailing Address - Phone:815-932-3540
Mailing Address - Fax:815-932-3611
Practice Address - Street 1:19 HERITAGE DR STE 209
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1369
Practice Address - Country:US
Practice Address - Phone:815-932-3540
Practice Address - Fax:815-932-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090701208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty