Provider Demographics
NPI:1992778336
Name:BANI HANI, AHMAD HESHAM (MD)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:HESHAM
Last Name:BANI HANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AHMAD
Other - Middle Name:H
Other - Last Name:BANI HANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:TEXAS CHILDRENS HOSPITAL, 6621 FANNIN STEET
Mailing Address - Street 2:DIVISION OF PEDIATRIC UROLOGY
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:832-824-1000
Mailing Address - Fax:
Practice Address - Street 1:6621 FANNIN SREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:832-824-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45653208800000X
DEC100087592088P0231X
PAMD4338702088P0231X
TXU53492088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN677667100Medicaid
MD4158211Medicaid
PA102269660Medicaid
NJ0178888Medicaid
MN677667100Medicaid
NJ0178888Medicaid
MNP00041307Medicare ID - Type UnspecifiedRAILROAD
MN340000774Medicare ID - Type Unspecified