Individual
WADE L BANKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-1700
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
(216) 844-1700
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
19652
MS
2085R0202X
Diagnostic Radiology Physician
Primary
35074019
OH
2085R0204X
Vascular & Interventional Radiology Physician
35074019
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08059068
—
MS
05
—
2285861
—
OH
01
—
300002000
MEDICARE
MS
01
—
512G700003
MS MEDICARE - GROUP
MS
01
—
P00393376
RAILROAD MEDICARE
MS
Enumeration date
08/20/2006
Last updated
09/25/2013
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