Sirirat R Banuchi, M.D
Individual provider Active NPI Procedural Dermatology Physician · Chicago, IL
NPI 1164529087 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1164529087
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Procedural Dermatology Physician 207NS0135X
- License
- 36046827 (IL)
- Practice address
- 4849 N Milwaukee Ave
Chicago, IL 60630-5100 - Phone
- (773) 545-3123
- Fax
- (773) 545-3886
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36046827 | IL | MD | Procedural Dermatology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Procedural Dermatology Physician | 207NS0135X | 36046827 | IL | Yes |
Addresses
Primary practice location
4849 N Milwaukee Ave
Chicago, IL 60630-5100
Mailing address
4849 N Milwaukee Ave
Chicago, IL 60630-5100
Phone (773) 545-3123
Other providers in Chicago, IL
- James M Bansberg
- Frederic A Banser
- Sarah Banser
- Julia Lynn Banta
- Rakshanda Banu
- Bryan Banuelos Ramirez
- Cesiah Banuelos
- Daniel Carlos Banuelos
- Nuvia Banuelos
- Eleanor Resane Banzon
All providers in Chicago, IL · Procedural Dermatology Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.