Provider Demographics
NPI:1154508075
Name:BANKS, JOE EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:EDWARD
Last Name:BANKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JOE
Other - Middle Name:EDWARD
Other - Last Name:BANKS
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:333 W HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-3632
Mailing Address - Country:US
Mailing Address - Phone:574-304-0428
Mailing Address - Fax:317-602-7531
Practice Address - Street 1:234 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46225-2121
Practice Address - Country:US
Practice Address - Phone:317-954-8659
Practice Address - Fax:317-781-0470
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003296A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000567706OtherBCBS
IN000000665120OtherANTHEM FMC
IN200906930Medicaid
IN200906930Medicaid
IN184640CCMedicare PIN