Provider Demographics
NPI:1821546938
Name:BANATHIA, ANOOP (CRNA)
Entity Type:Individual
Prefix:
First Name:ANOOP
Middle Name:
Last Name:BANATHIA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60164-1002
Mailing Address - Country:US
Mailing Address - Phone:847-260-5115
Mailing Address - Fax:
Practice Address - Street 1:2912 MARION AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60164-1002
Practice Address - Country:US
Practice Address - Phone:847-260-5115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-18
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015301367500000X
IL041.382319163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse