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NPI Code Detail

MEDICARE: WILLIE BANKS GED

MEDICARE: WILLIE BANKS GED
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
1332BP3500XParenteral & Enteral Nutrition Supplies (DME)

General Provider Information

NPI Number : 1982356192
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIE BANKS GED
Provider Business Mailing Address
First Line : 5921 S CARPENTER ST
Second Line :
City : CHICAGO
State : IL
Zip : 60621-1433
Country : US
Telephone Number : 773-456-7533
Fax Number :
Provider Business Practice Location Address
First Line : 5921 S CARPENTER ST
Second Line :
City : CHICAGO
State : IL
Zip : 60621-1433
Country : US
Telephone Number : 773-456-7533
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2022
Last Update Date : 01/19/2022

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