MEDICARE: JOHN J BANIEWICZ 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	207R00000X	Internal Medicine Physician	35-058500	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285740530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN J BANIEWICZ MD

Provider Business Mailing Address
First Line	:	36000 EUCLID AVE
Second Line	:	MSO
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094
Country	:	US
Telephone Number	:	440-953-6082
Fax Number	:	440-953-6101

Provider Business Practice Location Address
First Line	:	9485 MENTOR AVE
Second Line	:	STE 210
City	:	MENTOR
State	:	OH
Zip	:	44060
Country	:	US
Telephone Number	:	440-205-5835
Fax Number	:	440-205-5735

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	03/01/2021

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