Provider Demographics
NPI:1871004465
Name:BANAS, DAVID J
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:BANAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5321 N DELPHIA AVE APT 122
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-4620
Mailing Address - Country:US
Mailing Address - Phone:773-458-0086
Mailing Address - Fax:
Practice Address - Street 1:5321 N DELPHIA AVE APT 122
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-4620
Practice Address - Country:US
Practice Address - Phone:773-458-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490181761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical