MEDICARE: RECARDO BANKS

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1487052924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RECARDO BANKS

Provider Business Mailing Address
First Line	:	18247 ASBURY PARK
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-3105
Country	:	US
Telephone Number	:	313-422-3635
Fax Number	:

Provider Business Practice Location Address
First Line	:	18247 ASBURY PARK
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-3105
Country	:	US
Telephone Number	:	313-422-3635
Fax Number	:

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

Provider Enumeration Date	:	12/16/2014
Last Update Date	:	12/16/2014

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Directions to “ RECARDO BANKS ” Practice Location

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