Provider Demographics
NPI:1841469830
Name:SULEMAN J. BANGASH D.O.S.C.
Entity type:Organization
Organization Name:SULEMAN J. BANGASH D.O.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SULEMAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BANGASH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-944-3391
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:
Mailing Address - Fax:
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:586-944-3391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116375207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty