Most Relevant Information
Provider Data
| NPI Number: | 1003676289 |
| Provider Name: | MICHAEL BRIAN BANIK APRN |
| Entity Type: | Individual |
| Taxonomy Code: | 363LC0200X |
| Specialty: | Nurse Practitioner |
| License Number: | 13088 |
Most Important Dates
| Enumeration Date: | 03/22/2024 |
| Last Updated: | 04/09/2024 |
Provider Practice Location
80 SEYMOUR ST
HARTFORD
CT
061063315
Practice Location Phone/Fax
| Phone: | 8605455000 |
| Fax: |
Provider Mailing Location
80 SEYMOUR ST
HARTFORD
CT
061063300
Provider Mailing Phone/Fax
| Phone: | 8605455000 |
| Fax: |