Provider Demographics
NPI:1124095666
Name:MECHAEL, BAN (MD)
Entity type:Individual
Prefix:MRS
First Name:BAN
Middle Name:
Last Name:MECHAEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19930 FARMINGTON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152
Mailing Address - Country:US
Mailing Address - Phone:248-476-6209
Mailing Address - Fax:248-476-6237
Practice Address - Street 1:19930 FARMINGTON RD
Practice Address - Street 2:SUITE A
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1433
Practice Address - Country:US
Practice Address - Phone:248-476-6209
Practice Address - Fax:248-476-6237
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBM073200208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI440931010Medicaid
MI1106331411OtherBCBS
MI440931010Medicaid
ON50840Medicare PIN