Provider Demographics
NPI:1972624104
Name:BANAS, JOHN S (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:BANAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 N DEARBORN PKWY
Mailing Address - Street 2:SUITE 20N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1446
Mailing Address - Country:US
Mailing Address - Phone:312-649-0303
Mailing Address - Fax:
Practice Address - Street 1:1530 N DEARBORN PKWY
Practice Address - Street 2:SUITE 20N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1446
Practice Address - Country:US
Practice Address - Phone:312-649-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA28279207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease