Individual
DR. DONALD ROST BANIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O., MPH
Contact information
Practice address
2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454-1450
(612) 273-8700
Mailing address
720 WASHINGTON AVE SE, SUITE 300, MINNEAPOLIS, MN 55414-2924
(612) 884-0301
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
57168
MN
2084P0800X
Psychiatry Physician
LP00915
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107219
MINNESOTA MEDICAL LICENSE
MN
01
—
1447312160
BLUECROSS/ BLUESHIELD OF MN
MN
Enumeration date
12/16/2006
Last updated
01/24/2014
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