Healthcare Provider Details

I. General information

NPI: 1083024616
Provider Name (Legal Business Name): MICHAEL BANKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 LEXINGTON AVE
ASHLAND KY
41101-2843
US

IV. Provider business mailing address

1249 15TH ST SUITE 2000
HUNTINGTON WV
25701-3662
US

V. Phone/Fax

Practice location:
  • Phone: 606-408-4000
  • Fax:
Mailing address:
  • Phone: 304-691-1000
  • Fax: 304-691-1693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number49874
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number49874
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: