Provider Demographics
NPI:1891882536
Name:BANERIAN, KIRK G (MD)
Entity Type:Individual
Prefix:MISS
First Name:KIRK
Middle Name:G
Last Name:BANERIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3401 LUDINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-1300
Mailing Address - Country:US
Mailing Address - Phone:906-786-3311
Mailing Address - Fax:906-789-0941
Practice Address - Street 1:3401 LUDINGTON STREET
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1300
Practice Address - Country:US
Practice Address - Phone:906-786-3311
Practice Address - Fax:906-789-0941
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME763352085N0700X, 2085R0202X
MI43010487872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016623400Medicaid
MI495680OtherHAP
MI0Q26008OtherBCN OF MICHIGAN
MI4550607Medicaid
371664910OtherHEALTH NET FED SERVICES
MI0Q26008OtherBCBS OF MICHIGAN
MI1006439OtherMCCLAREN
MISJ820005OtherM-CARE
0Q26008054OtherFEDERAL BLACK LUNG
P00067927OtherRR MEDICARE
MISJ820005OtherM-CARE