Healthcare Provider Details

I. General information

NPI: 1881735595
Provider Name (Legal Business Name): FRANK J BANIEWICZ JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FRANCIS J BANIEWICZ JR. MD

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W PINHOOK RD
LAFAYETTE LA
70508-3346
US

IV. Provider business mailing address

600 ROBERT LEE CIR
LAFAYETTE LA
70506-3139
US

V. Phone/Fax

Practice location:
  • Phone: 337-269-0136
  • Fax: 337-233-8525
Mailing address:
  • Phone: 337-234-9681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberMD201098
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: