Provider Demographics
NPI:1588167522
Name:KAYSIE L BANTON, MD, PC
Entity type:Organization
Organization Name:KAYSIE L BANTON, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAYSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BANTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-220-3708
Mailing Address - Street 1:3358 S EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2832
Mailing Address - Country:US
Mailing Address - Phone:612-220-3708
Mailing Address - Fax:
Practice Address - Street 1:601 E HAMPDEN AVE STE 220
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3781
Practice Address - Country:US
Practice Address - Phone:303-788-5300
Practice Address - Fax:303-788-5363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0059860208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty