Individual
JOHN J BANIEWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9485 MENTOR AVE, STE 210, MENTOR, OH 44060
(440) 205-5835
(440) 205-5735
Mailing address
36000 EUCLID AVE, MSO, WILLOUGHBY, OH 44094
(440) 953-6082
(440) 953-6101
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35-058500
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0854160
—
OH
Enumeration date
08/21/2006
Last updated
03/01/2021
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