Provider Demographics
NPI:1063155570
Name:BANU MEDICAL PRACTICE PA
Entity type:Organization
Organization Name:BANU MEDICAL PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FULVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-205-6071
Mailing Address - Street 1:2 S UNIVERSITY DR STE 330
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3307
Mailing Address - Country:US
Mailing Address - Phone:954-205-6071
Mailing Address - Fax:954-820-9652
Practice Address - Street 1:2 S UNIVERSITY DR STE 330
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3307
Practice Address - Country:US
Practice Address - Phone:954-205-6071
Practice Address - Fax:954-820-9652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty