Individual
LARRY WILLIAM BANYASH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2610 E JEFFERSON BLVD, SOUTH BEND, IN 46615-2724
(574) 232-3000
(574) 236-4409
Mailing address
2610 E JEFFERSON BLVD, SOUTH BEND, IN 46615-2724
(574) 232-3000
(574) 236-4409
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01029868A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000383044
BLUE CROSS
IN
Enumeration date
01/24/2006
Last updated
07/08/2007
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