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NPI Code Detail

MEDICARE: JON MICHAEL BANAS DO

MEDICARE: JON MICHAEL BANAS DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician036100431IL
22085R0202XDiagnostic Radiology PhysicianOS10560FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00801888OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598750747
Entity Type Code : Individual
Provider Name (Legal Business Name) : JON MICHAEL BANAS DO
Provider Business Mailing Address
First Line : 3660 BROADWAY
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-8005
Country : US
Telephone Number : 239-936-2316
Fax Number : 239-931-6365
Provider Business Practice Location Address
First Line : 3680 BROADWAY
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-8005
Country : US
Telephone Number : 239-936-2316
Fax Number : 239-931-6365
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2005
Last Update Date : 02/10/2011

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