Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 27991 | WV |
N | 111NI0900X | Internist | 27991 | WV |
N | 207R00000X | Internist | 4301098860 | MI |
N | 111NI0900X | Internist | 4301098860 | MI |
Y | 207RC0200X | Critical Care Medicine | 27991 | WV |
N | 207RC0200X | Critical Care Medicine | 60022 | MN |
N | 207RN0300X | Nephrologist | 27991 | WV |
NPI | 1023397114 |
---|---|
Provider Name | Ghassan Salim Issa Bandak |
First Address | Rochester, MN 55905-0001 |
Second Address | Huntington, WV 25701-3663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2011 |
Last Update Date | 19/11/2021 |