Provider Demographics
NPI:1023007192
Name:BANTER, AMY E (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:E
Last Name:BANTER
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 1:11693 FALL CREEK RD STE 140
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-9446
Mailing Address - Country:US
Mailing Address - Phone:317-703-4431
Mailing Address - Fax:866-475-6765
Practice Address - Street 1:11693 FALL CREEK RD STE 140
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-9446
Practice Address - Country:US
Practice Address - Phone:317-703-4431
Practice Address - Fax:866-475-6765
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045411207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200173180Medicaid
INM400050013Medicare PIN
IN255310BMedicare PIN
IN200173180Medicaid
IN151560OOMedicare PIN
IN255310BMedicare PIN