Provider Demographics
NPI:1679765309
Name:BANKS, MINDY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:ANN
Last Name:BANKS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-301-9010
Mailing Address - Fax:303-832-3721
Practice Address - Street 1:2055 N HIGH ST
Practice Address - Street 2:#330
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5503
Practice Address - Country:US
Practice Address - Phone:303-301-9010
Practice Address - Fax:303-832-3721
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-114083207RN0300X, 2080P0210X
CO476562080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1679765309Medicaid
CO34734350Medicaid
WY128371500Medicaid
SD1679765309Medicaid
NE10025764100Medicaid
KS200635390AMedicaid
CO353950YLK2Medicare PIN