MEDICARE: DR. JOSEPH C. BANIS JR. MD

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	2086S0122X	Plastic and Reconstructive Surgery Physician	21531	KY

General Provider Information

NPI Number	:	1093717274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH C. BANIS JR. MD

Provider Business Mailing Address
First Line	:	2507 BUSH RIDGE DR STE B
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40245-5885
Country	:	US
Telephone Number	:	502-589-8000
Fax Number	:	502-589-8001

Provider Business Practice Location Address
First Line	:	2507 BUSH RIDGE DR STE B
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40245-5885
Country	:	US
Telephone Number	:	502-589-8000
Fax Number	:	502-589-8001

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	05/07/2019

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