Provider Demographics
NPI:1942265756
Name:BANNER, JAMES D (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:BANNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:406 E ELM ST
Mailing Address - Street 2:PO BOX 879
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811
Mailing Address - Country:US
Mailing Address - Phone:989-584-3971
Mailing Address - Fax:989-584-3729
Practice Address - Street 1:406 E ELM ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811
Practice Address - Country:US
Practice Address - Phone:989-584-3971
Practice Address - Fax:989-584-3729
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011192207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2675872Medicaid
A13510Medicare UPIN