Individual
BANKS WALTER KOOKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
720 ESKENAZI AVE, INDIANAPOLIS, IN 46202-5187
(317) 880-0000
Mailing address
1120 W MICHIGAN ST OFC CL285, INDIANAPOLIS, IN 46202-5209
(317) 278-0042
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2023-01844
NC
207RP1001X
Pulmonary Disease Physician
Primary
01093215A
IN
390200000X
Student in an Organized Health Care Education/Training Program
2023-01844
NC
Other
Enumeration date
03/23/2020
Last updated
06/26/2024
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