Provider Demographics
NPI:1588730121
Name:BANJO, CHAIM (MD PHD)
Entity type:Individual
Prefix:DR
First Name:CHAIM
Middle Name:
Last Name:BANJO
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 W MOORE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-3130
Mailing Address - Country:US
Mailing Address - Phone:972-551-1900
Mailing Address - Fax:972-551-1974
Practice Address - Street 1:718 W MOORE AVE STE 101
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-3130
Practice Address - Country:US
Practice Address - Phone:972-551-1900
Practice Address - Fax:972-551-1974
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4442207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128058804Medicaid
1588730121OtherMEDICARE
TX128058802Medicaid
TX00G25OtherBCBS
TX109453401Medicaid
TX82G516OtherBCBS
TX85A011OtherBCBS
TX128058803Medicaid
TX82G516OtherBCBS
TX00G25OtherBCBS
C13129Medicare UPIN
TX00GE25Medicare PIN
TX82G516Medicare PIN