Individual
JODY BANISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
300 LAFAYETTE AVE SE, SUITE 3000, GRAND RAPIDS, MI 49503-4650
(616) 685-6919
(616) 685-3063
Mailing address
245 STATE ST SE, GRAND RAPIDS, MI 49503-4328
(616) 685-1808
(616) 685-1850
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301076654
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4529345
—
MI
05
—
4529354
—
MI
05
—
4545680
—
MI
05
—
4877035
—
MI
05
—
4877840
—
MI
Enumeration date
05/17/2006
Last updated
10/05/2010
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