Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | R74164 | AZ |
N | 111NI0900X | Internist | R74164 | AZ |
Y | 207RG0300X | Geriatric Medicine | 52640 | AZ |
NPI | 1134569494 |
---|---|
Provider Name | Dr. Kareem Bannis |
First Address | Phoenix, AZ 85012-2808 |
Second Address | Phoenix, AZ 85013-4218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2013 |
Last Update Date | 02/11/2020 |