Individual
MR. MICHAEL R. BANTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13100 MANCHESTER RD STE 150, SAINT LOUIS, MO 63131-1743
(314) 692-7886
(314) 692-7929
Mailing address
13100 MANCHESTER RD STE 150, SAINT LOUIS, MO 63131-1743
(314) 692-7886
(314) 692-7929
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
R1J81
MO
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
R1J81
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
132484
HEALTHLINK
MO
01
—
1511221
UNITED HEALTHCARE
MO
05
—
202842001
—
MO
01
—
23064
BLUE SHEILD
MO
01
—
260012274
CHAMPUS
MO
01
—
4222764
AETNA
MO
Enumeration date
08/02/2006
Last updated
11/08/2017
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