Provider Demographics
NPI:1033157169
Name:BANKER, MICHAEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:BANKER
Suffix:
Gender:M
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:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-0032
Mailing Address - Country:US
Mailing Address - Phone:847-593-8460
Mailing Address - Fax:847-919-4615
Practice Address - Street 1:2965 OCEAN PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8014
Practice Address - Country:US
Practice Address - Phone:718-280-5573
Practice Address - Fax:718-301-1099
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238100208G00000X
NY167314208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010229871Medicaid
NY01410860Medicaid
009420V61Medicare ID - Type Unspecified
VAVAA102389Medicare PIN
MDDO6229Medicare PIN
MDP00888656Medicare PIN
VA010229871Medicaid
VAP00907631Medicare PIN
VADR1715Medicare PIN