Provider Demographics
NPI:1528096146
Name:BANKS, JOEY MICHELE (MD)
Entity type:Individual
Prefix:
First Name:JOEY
Middle Name:MICHELE
Last Name:BANKS
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 1:121 HICKORY ST STE 4
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1896
Mailing Address - Country:US
Mailing Address - Phone:406-541-2012
Mailing Address - Fax:
Practice Address - Street 1:121 HICKORY ST STE 4
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-1896
Practice Address - Country:US
Practice Address - Phone:406-541-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK34204207Q00000X
NM0903207Q00000X
IL161340207Q00000X
MT12588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD10595Medicaid
AKMD10595Medicaid