Basic Information
| Provider Information | |||||||||
| NPI: | 1518922962 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BANKS | ||||||||
| FirstName: | PEGGY | ||||||||
| MiddleName: | SCHUTTE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4201 W MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600508409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157593100 | ||||||||
| FaxNumber: | 8153639094 | ||||||||
| Practice Location | |||||||||
| Address1: | 4201 W MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157593100 | ||||||||
| FaxNumber: | 8153639094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 02002258A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 036105438 | IL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200175310 | 05 | IN | MEDICAID | P00277561 | 01 | IN | MEDICARE RAILROAD | OTHER | 000000387519 | 01 | IN | ANTHEM | OTHER | 90001082 | 01 | IL | BCBS | OTHER | 036105438 | 01 | IL | STATE LICENSE | OTHER |