MEDICARE: DR. MICHAEL DUANE BANYAI M.D.

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
1	207R00000X	Internal Medicine Physician	MB042274	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MB042274	OTHER	MI	STATE LICENSE

General Provider Information

NPI Number	:	1598799785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DUANE BANYAI M.D.

Provider Business Mailing Address
First Line	:	1890 S US HIGHWAY 131
Second Line	:	SUITE 4
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8344
Country	:	US
Telephone Number	:	231-487-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1890 S US HIGHWAY 131
Second Line	:	SUITE 4
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8344
Country	:	US
Telephone Number	:	231-487-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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