Provider Demographics
NPI:1063622637
Name:BANU, HUSSAIN (MBBS)
Entity type:Individual
Prefix:DR
First Name:HUSSAIN
Middle Name:
Last Name:BANU
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-467-2000
Mailing Address - Fax:319-467-2814
Practice Address - Street 1:920 E 2ND AVE STE 201
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2225
Practice Address - Country:US
Practice Address - Phone:319-467-2000
Practice Address - Fax:319-467-2814
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-37923207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1063622637Medicaid
IA71926077Medicare PIN