Provider Demographics
NPI:1649220849
Name:BANKS, GARRY M (MD)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:M
Last Name:BANKS
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 1:8290 UNIVERSITY AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-1876
Mailing Address - Country:US
Mailing Address - Phone:763-786-9543
Mailing Address - Fax:763-786-3320
Practice Address - Street 1:8290 UNIVERSITY AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-1876
Practice Address - Country:US
Practice Address - Phone:763-786-9543
Practice Address - Fax:763-786-3320
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33956207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1649220849Medicaid
MN0907746OtherMEDICA
MN38Q19BAOtherBLUE CROSS BLUE SHIELD
MN936131000801OtherPREFERRED ONE
MN23958OtherARAZ
MN200033239OtherRAILROAD MEDICARE
MNHP26628OtherHEALTH PARTNERS
MN920508000Medicaid
MNE82880Medicare UPIN
MN200001344Medicare ID - Type Unspecified