Active NPI
John Mike Banowetz, MD
- Neurology Physician
- Oklahoma City, OK
National Provider Identifier
1801867254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 10184
- Practice address
- 4120 W Memorial Rd
#218
Oklahoma City, OK 73120 - Phone
- (405) 302-2661
- Fax
- (405) 302-2670
- NPI assigned
- Feb 1, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 10184 | OK | Primary |
Addresses
Primary practice location
4120 W Memorial Rd
#218
Oklahoma City, OK 73120
Mailing address
4401 W Memorial Rd
Suite 140
Oklahoma City, OK 73134-1785
Phone (405) 752-3162
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100128980A | Medicaid | OK |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10184 | OK | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398038400000",
"number": "1801867254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4401 W MEMORIAL RD",
"address_2": "SUITE 140",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731341785",
"telephone_number": "405-752-3162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4120 W MEMORIAL RD",
"address_2": "#218",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "73120",
"telephone_number": "405-302-2661",
"fax_number": "405-302-2670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANOWETZ",
"first_name": "JOHN",
"middle_name": "MIKE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-01",
"last_updated": "2014-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "OK",
"license": "10184",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100128980A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.