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Individual
DR. THOMAS R BANNOW
Active
Individual
DR. THOMAS R BANNOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
TB006643
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080186042
RR MEDICARE
MI
01
—
0852834554
BLUE SHIELD
MI
05
—
112773461
—
MI
01
—
136442
CARE CHOICE
MI
01
—
5120235
AETNA
MI
01
—
E26799
PRIORITY
MI
Enumeration date
02/03/2006
Last updated
10/04/2011
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