MEDICARE: RICHARD M BANOZIC M.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	207R00000X	Internal Medicine Physician	35067230	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	9338635	OTHER	OH	PARTNERS PHYSICIAN GROUP MEDICARE GROUP #

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
2	1770896268	OTHER	OH	TALLMADGE INTERNAL MEDICINE SPECIALISTS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1841239274	OTHER	OH	PARTNERS PHYSICIAN GROUP TYPE 2 NPI #

General Provider Information

NPI Number	:	1487648408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD M BANOZIC M.D.

Provider Business Mailing Address
First Line	:	6847 N. CHESTNUT STREET
Second Line	:	SUITE 310
City	:	RAVENNA
State	:	OH
Zip	:	44266
Country	:	US
Telephone Number	:	330-296-2819
Fax Number	:	330-297-9503

Provider Business Practice Location Address
First Line	:	6847 N. CHESTNUT STREET
Second Line	:	SUITE 310
City	:	RAVENNA
State	:	OH
Zip	:	44266
Country	:	US
Telephone Number	:	330-296-2819
Fax Number	:	330-297-9503

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	12/22/2014

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