MEDICARE: PORSCHE BANKS PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704335074	MI

General Provider Information

NPI Number	:	1316829989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PORSCHE BANKS PMHNP

Provider Business Mailing Address
First Line	:	25900 GREENFIELD RD STE 380
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-1223
Country	:	US
Telephone Number	:	313-220-2970
Fax Number	:

Provider Business Practice Location Address
First Line	:	2911 GROVES DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3632
Country	:	US
Telephone Number	:	313-220-2970
Fax Number	:

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

Provider Enumeration Date	:	07/23/2025
Last Update Date	:	02/19/2026

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