Individual
THOMAS MARK BANAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7956 WEST JEFFERSON BLVD, FORT WAYNE, IN 46804-4159
(260) 436-2416
(260) 436-9662
Mailing address
7956 WEST JEFFERSON BLVD, FORT WAYNE, IN 46804-4159
(260) 436-2416
(260) 436-9662
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01040131A
IN
2084N0400X
Neurology Physician
2020-03917
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0878279
—
OH
05
—
100319490
—
IN
01
—
130006861
RR MEDICARE
IN
05
—
1508863051
—
NC
05
—
4132886
—
MI
Enumeration date
06/30/2005
Last updated
10/23/2023
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