Provider Demographics
NPI:1942302864
Name:BANGASH, SULEMAN J (DO)
Entity Type:Individual
Prefix:DR
First Name:SULEMAN
Middle Name:J
Last Name:BANGASH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 N RANDALL RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-7900
Mailing Address - Country:US
Mailing Address - Phone:847-608-6647
Mailing Address - Fax:847-608-6674
Practice Address - Street 1:1750 N RANDALL RD
Practice Address - Street 2:SUITE 120
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-7900
Practice Address - Country:US
Practice Address - Phone:847-608-6647
Practice Address - Fax:847-608-6674
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116375207N00000X
FLOS9518207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216665OtherMEDICARE GROUP PTAN
ILK50412OtherMEDICARE INDIVIDUAL PTAN
FL160582OtherBLUE CROSS BLUE SHIELD
ILF400179686OtherMEDICARE INDIVIDUAL PTAN
ILK51558OtherMEDICARE INDIVIDUAL PTAN
IL216361OtherMEDICARE GROUP PTAN
ILF100179678OtherMEDICARE GROUP PTAN
FLI40033Medicare UPIN
ILF100179678OtherMEDICARE GROUP PTAN