Provider Demographics
NPI:1427264456
Name:PANDELIS BANIAS, M.D., S.C.
Entity type:Organization
Organization Name:PANDELIS BANIAS, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PANDELIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:BANIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-316-4455
Mailing Address - Street 1:800 AUSTIN ST
Mailing Address - Street 2:EAST TOWER, SUITE 369
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3439
Mailing Address - Country:US
Mailing Address - Phone:847-316-4455
Mailing Address - Fax:847-316-4456
Practice Address - Street 1:800 AUSTIN ST
Practice Address - Street 2:EAST TOWER, SUITE 369
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3439
Practice Address - Country:US
Practice Address - Phone:847-316-4455
Practice Address - Fax:847-316-4456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01625523OtherINDIVIDUAL BLUE SHIELD ID
IL570320Medicare PIN
IL01625523OtherINDIVIDUAL BLUE SHIELD ID