Individual
P MICHAEL BANASIK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
(608) 775-4467
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
(608) 775-4467
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5000273
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33663300
—
WI
Enumeration date
06/08/2005
Last updated
07/08/2007
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