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NPI Code Detail

MEDICARE: MYESHA JANELL BANKS M.D.

MEDICARE: MYESHA JANELL BANKS 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
1208000000XPediatrics Physician125050971IL

General Provider Information

NPI Number : 1821258724
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYESHA JANELL BANKS M.D.
Provider Business Mailing Address
First Line : 5159 S ASHLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60609-4931
Country : US
Telephone Number : 773-434-9216
Fax Number : 773-434-2670
Provider Business Practice Location Address
First Line : 5159 S ASHLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60609-4931
Country : US
Telephone Number : 773-434-9216
Fax Number : 773-434-2670
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2008
Last Update Date : 05/01/2012

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Directions to “ MYESHA JANELL BANKS M.D.” Practice Location

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