MEDICARE: GERALDINE B BANKS PH D

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	103T00000X	Psychologist	1543 057	WI
2	103TC0700X	Clinical Psychologist	1543-057	WI

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	:	1356369854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALDINE B BANKS PH D

Provider Business Mailing Address
First Line	:	5900 N PORT WASHINGTON RD
Second Line	:	SUITE 230
City	:	GLENDALE
State	:	WI
Zip	:	53217-4503
Country	:	US
Telephone Number	:	414-962-4048
Fax Number	:	414-962-4052

Provider Business Practice Location Address
First Line	:	5900 N PORT WASHINGTON RD
Second Line	:	SUITE 230
City	:	GLENDALE
State	:	WI
Zip	:	53217-4503
Country	:	US
Telephone Number	:	414-962-4048
Fax Number	:	414-962-4052

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	02/06/2026

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