Active NPI
Lori Susan Banaszak, MD
- Family Medicine Physician
- Minneapolis, MN
National Provider Identifier
1669583126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 37715
- Practice address
- 1213 E Franklin Ave
Minneapolis, MN 55404-2923 - Phone
- (612) 872-8086
- Fax
- (612) 872-8547
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 37715 | MN | Primary |
Addresses
Primary practice location
1213 E Franklin Ave
Minneapolis, MN 55404-2923
Mailing address
1213 E Franklin Ave
Minneapolis, MN 55404-2923
Phone (612) 872-8086
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 942016900 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359936000000",
"number": "1669583126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1213 E FRANKLIN AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554042923",
"telephone_number": "612-872-8086",
"fax_number": "612-872-8547"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1213 E FRANKLIN AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554042923",
"telephone_number": "612-872-8086",
"fax_number": "612-872-8547"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANASZAK",
"first_name": "LORI",
"middle_name": "SUSAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2013-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "37715",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "942016900",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.