Individual
DR. MARK KOREA BANNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
27970 ORCHARD LAKE RD STE 1, FARMINGTON HILLS MEDICAL GROUP, FARMINGTON HILLS, MI 48334-3767
(248) 626-1999
(248) 626-7555
Mailing address
27970 ORCHARD LAKE RD STE 1, FARMINGTON HILLS MEDICAL GROUP, FARMINGTON HILLS, MI 48334-3767
(248) 626-1999
(248) 626-7555
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301094195
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0P33970011
MEDICARE P-TAN
MI
Enumeration date
06/22/2009
Last updated
11/15/2014
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