MOUSTAFA BANNA MD NPI 1003009861

Internal Medicine (Cardiovascular Disease) in Glendale, AZ

About MOUSTAFA BANNA

Moustafa Banna is a provider in Glendale, AZ with more than 13 years of experience. The NPI number assigned to this provider is 1003009861. The practitioner's primary taxonomy code is Internal Medicine (207RC0000X). The provider is registered as an individual and their NPI record was last updated 2 years ago. Moustafa Banna is registered with Medicare and accepts claims assignment.

NPI1003009861 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider Name MOUSTAFA BANNA MD
Provider Location Address5859 W. TALAVI BLVD SUITE 100 GLENDALE, AZ 85306 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address5859 W. TALAVI BLVD SUITE 100 GLENDALE, AZ 85306 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
GenderMale
NPI Entity TypeIndividual Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Medical School NameUNIVERSITY OF CINCINNATI COLLEGE OF MEDICINE
Graduation Year2005
Is Sole Proprietor?No
Is Organization Subpart?N/A Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date08-23-2007 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date11-16-2015 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

MOUSTAFA BANNA MD
5859 W. TALAVI BLVD
SUITE 100
GLENDALE, AZ
ZIP 85306
Phone: (602) 298-7777
Fax: (623) 930-6060
Get Directions

Mailing Address

MOUSTAFA BANNA MD
5859 W. TALAVI BLVD
SUITE 100
GLENDALE, AZ
ZIP 85306
Phone: (602) 298-7777
Fax: (623) 930-6060

Primary Taxonomy

Taxonomy Code207RC0000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationInternal Medicine
TypeAllopathic & Osteopathic Physicians
SpecializationCardiovascular Disease
License No.45263
License StateAZ
Taxonomy DescriptionAn internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseP6136TXNo

Taxonomy Description: an internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

2390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramMT186538PANo

Taxonomy Description: an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
324413901MEDICAID (05)TX
306459YKP5MEDICARE PIN (08)TX
324413902MEDICAID (05)TX
306459YKPWMEDICARE PIN (08)TX

Map Location


MOUSTAFA BANNA MD address is 5859 W. TALAVI BLVD SUITE 100 GLENDALE, AZ 85306