Provider Demographics
NPI:1649348749
Name:BANOVETZ, JAMES M (MD, PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:BANOVETZ
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 VINCENT ST
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1842
Mailing Address - Country:US
Mailing Address - Phone:715-344-0701
Mailing Address - Fax:715-344-4494
Practice Address - Street 1:500 VINCENT ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1842
Practice Address - Country:US
Practice Address - Phone:715-344-0701
Practice Address - Fax:715-344-4494
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37860207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32256800Medicaid
WIG11470Medicare UPIN