Provider Demographics
NPI:1932501533
Name:O'BANNON, LINDA CURTIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:CURTIS
Last Name:O'BANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 N HARBOR DR
Mailing Address - Street 2:APT. 2702
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7514
Mailing Address - Country:US
Mailing Address - Phone:312-565-0148
Mailing Address - Fax:
Practice Address - Street 1:195 N HARBOR DR
Practice Address - Street 2:APT. 2702
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7514
Practice Address - Country:US
Practice Address - Phone:312-565-0148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine