Provider Demographics
NPI:1588740955
Name:BANG, JANE (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:BANG
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 1:2800 N. SHERIDAN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:773-281-7835
Mailing Address - Fax:773-281-8736
Practice Address - Street 1:2800 N SHERIDAN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6156
Practice Address - Country:US
Practice Address - Phone:773-281-7835
Practice Address - Fax:773-281-8736
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623792OtherBLUE CROSS BLUE SHIELD
IL036113330Medicaid
IL01623792OtherBLUE CROSS BLUE SHIELD
IL599940Medicare ID - Type Unspecified