Provider Demographics
NPI:1104856848
Name:BANAS, MICHAEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:BANAS
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 1:220 S RIVER ST
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-1137
Mailing Address - Country:US
Mailing Address - Phone:570-826-1555
Mailing Address - Fax:570-822-4445
Practice Address - Street 1:220 S RIVER ST
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1137
Practice Address - Country:US
Practice Address - Phone:570-826-1555
Practice Address - Fax:570-822-4445
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052858L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000161889OtherBLUE SHIELD
PA0015018410005Medicaid
PR806950OtherFIRST PRIORITY
PA161889EKCMedicare PIN
PA000161889OtherBLUE SHIELD