Provider Demographics
NPI:1306926928
Name:MEDICAL NEUROLOGISTS INC
Entity type:Organization
Organization Name:MEDICAL NEUROLOGISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MIKE
Authorized Official - Last Name:BANOWETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-302-2661
Mailing Address - Street 1:4120 W MEMORIAL RD
Mailing Address - Street 2:STE 218
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120
Mailing Address - Country:US
Mailing Address - Phone:405-302-2661
Mailing Address - Fax:405-302-2670
Practice Address - Street 1:4120 W MEMORIAL RD
Practice Address - Street 2:STE 218
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120
Practice Address - Country:US
Practice Address - Phone:405-302-2661
Practice Address - Fax:405-302-2670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty