Provider Demographics
NPI:1982602629
Name:BANGAYAN, MARIBE FE (MD)
Entity type:Individual
Prefix:
First Name:MARIBE
Middle Name:FE
Last Name:BANGAYAN
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 1:5140 N. CALIFORNIA AVE.
Mailing Address - Street 2:SUITE 740-GMP
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625
Mailing Address - Country:US
Mailing Address - Phone:773-989-3957
Mailing Address - Fax:773-989-3971
Practice Address - Street 1:4640 N MARINE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5719
Practice Address - Country:US
Practice Address - Phone:773-564-5577
Practice Address - Fax:773-564-5578
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100866207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100866Medicaid
IL204573Medicare ID - Type Unspecified
ILG96363Medicare UPIN