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General NPI Number Information
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NPI Number | 1417006883
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Entity Type | Individual
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Provider Name | MICHAEL R BANITT M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/20/2021
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Provider Practice Location Address
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Address Line | 16404 SMOKEY POINT BLVD STE 303
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City | ARLINGTON
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State | WA
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Zip | 98223-8417
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Country | US
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Telephone | 360-658-6224
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Fax | 360-658-6227
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Provider Business Mailing Address
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Address Line | PO BOX 102339
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City | PASADENA
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State | CA
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Zip | 91189-2339
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Country | US
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Telephone | 206-528-6000
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Fax | 206-858-7050
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD60583808
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License Number State | WA
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