Provider Demographics
NPI:1760479398
Name:BANKS, HERMANN DARWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:HERMANN
Middle Name:DARWIN
Last Name:BANKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HERMANN
Other - Middle Name:DAWRIN
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:14700 FARMINGTON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5434
Mailing Address - Country:US
Mailing Address - Phone:734-525-5744
Mailing Address - Fax:734-525-3932
Practice Address - Street 1:14700 FARMINGTON RD STE 102
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5434
Practice Address - Country:US
Practice Address - Phone:734-525-5744
Practice Address - Fax:734-525-3932
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010644532084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4094874Medicaid
MIG94845Medicare UPIN
MIM25300003Medicare ID - Type Unspecified