Healthcare Provider Details

I. General information

NPI: 1679765309
Provider Name (Legal Business Name): MINDY ANN BANKS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 N HIGH ST #330
DENVER CO
80205-5503
US

IV. Provider business mailing address

4900 S MONACO ST SUITE 210
DENVER CO
80237-3486
US

V. Phone/Fax

Practice location:
  • Phone: 303-301-9010
  • Fax: 303-832-3721
Mailing address:
  • Phone: 303-301-9010
  • Fax: 303-832-3721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036-114083
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number036-114083
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number47656
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: