NPIMap

Individual provider Active NPI

Mark Korea Banno, M.D.

  • Family Medicine Physician
  • Farmington Hills, MI
National Provider Identifier
1669600219
Registry record updated Nov 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301094195 Issued in MI
Practice address
27970 Orchard Lake Rd Ste 1
Farmington Hills Medical Group
Farmington Hills, MI 48334-3767
Phone
(248) 626-1999
Fax
(248) 626-7555
NPI assigned
Jun 22, 2009
Last updated
Nov 15, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301094195 MI Primary

Addresses

Primary practice location

27970 Orchard Lake Rd Ste 1
Farmington Hills Medical Group
Farmington Hills, MI 48334-3767

Mailing address

27970 Orchard Lake Rd Ste 1
Farmington Hills Medical Group
Farmington Hills, MI 48334-3767
Phone (248) 626-1999

Other identifiers 1

IdentifierTypeStateIssuer
0P33970011OtherMIMEDICARE P-TAN

Other names 1

  • Dr. Mouwafak K Banno Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120911000685 MI Practitioner - Family Practice 2668620972 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Semi Medical GroupGroup PAC ID 0648180406, 246 clinicians

Practice addresses (Care Compare)

27970 Orchard Lake Rd
Suite 1
Farmington Hills, MI 48334-3767
Phone (248) 626-1999

33523 8 Mile Rd
Suite M2
Livonia, MI 48152-4119
Phone (248) 824-2675

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301094195MIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Semi Medical Group CurrentSince Aug 1, 2012 Accepting new patients
Agy Medical Group PC CurrentSince Aug 1, 2012 Accepting new patients
Henry Ford Semi Medical Group Family Medicine CurrentSince Aug 1, 2012 Accepting new patients
Ascension Macomb Oakland Hospital Past Accepting new patients

Locations

33523 8 Mile Rd
Ste M2
Livonia, MI 48152
Phone (248) 824-2675

30117 Schoenherr Rd
Ste 400
Warren, MI 48088
Phone (586) 552-4848

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416009600000",
    "number": "1669600219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27970 ORCHARD LAKE RD STE 1",
            "address_2": "FARMINGTON HILLS MEDICAL GROUP",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483343767",
            "telephone_number": "248-626-1999",
            "fax_number": "248-626-7555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27970 ORCHARD LAKE RD STE 1",
            "address_2": "FARMINGTON HILLS MEDICAL GROUP",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483343767",
            "telephone_number": "248-626-1999",
            "fax_number": "248-626-7555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANNO",
        "first_name": "MARK",
        "middle_name": "KOREA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-22",
        "last_updated": "2014-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301094195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE P-TAN",
            "identifier": "0P33970011",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MOUWAFAK",
            "last_name": "BANNO",
            "middle_name": "K",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Farmington Hills, MI

Sources for this page

Verify at the official NPI Registry.