Provider Demographics
NPI:1447471164
Name:BANAS, DAVID ALLAN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLAN
Last Name:BANAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-685-4614
Mailing Address - Fax:614-685-5025
Practice Address - Street 1:6700 UNIVERSITY BLVD STE 3D
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-3508
Practice Address - Country:US
Practice Address - Phone:614-685-4614
Practice Address - Fax:614-685-5025
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-088148207Q00000X, 207QA0000X, 207QA0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0053642Medicaid
PA2115021OtherHIGHMARK
PA1023316780002Medicaid
MI1447471164OtherMI MEDICAID
PA1023316780002Medicaid
OH0053642Medicaid
PA158786K1ZMedicare PIN
OHH046332Medicare PIN