Provider Demographics
NPI:1356365654
Name:BANKS, MICHELLE C (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:C
Last Name:BANKS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:323 N PRAIRIE AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4502
Mailing Address - Country:US
Mailing Address - Phone:310-673-5774
Mailing Address - Fax:310-673-9729
Practice Address - Street 1:323 N PRAIRIE AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4502
Practice Address - Country:US
Practice Address - Phone:310-673-5774
Practice Address - Fax:310-673-9729
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-04-15
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Provider Licenses
StateLicense IDTaxonomies
CAA65827207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A658270OtherMEDI CAL
CAWA65827AMedicare ID - Type Unspecified
CA00A658270OtherMEDI CAL