Provider Demographics
NPI:1740232685
Name:BANERJI, INDRANEEL (MD)
Entity Type:Individual
Prefix:MR
First Name:INDRANEEL
Middle Name:
Last Name:BANERJI
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 1:5352 BECKLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015
Mailing Address - Country:US
Mailing Address - Phone:269-979-9400
Mailing Address - Fax:269-979-2091
Practice Address - Street 1:300 NORTH AVENUE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017
Practice Address - Country:US
Practice Address - Phone:269-966-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010679712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4409928100Medicaid
MI4409928100Medicaid
0A36011015Medicare ID - Type Unspecified