Provider Demographics
NPI:1386639813
Name:BANERJEE, AMITABHA (MD)
Entity Type:Individual
Prefix:DR
First Name:AMITABHA
Middle Name:
Last Name:BANERJEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:G1125 SOUTH LINDEN RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532
Mailing Address - Country:US
Mailing Address - Phone:810-230-2323
Mailing Address - Fax:810-732-3199
Practice Address - Street 1:1125 S LINDEN RD
Practice Address - Street 2:SUITE 500
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4073
Practice Address - Country:US
Practice Address - Phone:810-230-2323
Practice Address - Fax:810-732-3199
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301037964208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA78983Medicare UPIN