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KELLY A BANNASCH PA-C
NPI 1043330889
Physician Assistant - Medical in Detroit, MI

Active since March 29, 2007
6071 W OUTER DR, DETROIT, MI 48235(313) 966-8559 Get Directions Write a Review

NPPES record last updated: January 24, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kelly A Bannasch Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY A BANNASCH PA-C (NPI 1043330889) is an individual medical provider in Detroit, Michigan, licensed in Michigan (5601002420) and active in the NPI registry since March 2007.

NPPES Registry Identity

NPI1043330889
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameKELLY A BANNASCHCredential: PA-C
Location Address6071 W OUTER DRDetroit, MI 48235-2624
Mailing Address6071 W Outer DrDetroit, MI 48235-2624 · (313) 966-8559
Phone(313) 966-8559
Sole ProprietorNo
Enumeration DateMarch 29, 2007
Last NPPES UpdateJanuary 24, 2012
✔ NPI 1043330889 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in MI · 5601002420
6071 W OUTER DR, Detroit, MI 48235
Open in Google Maps ↗

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. LILIA POPADIUK P.A.
Physician Assistant
6071 W OUTER DR
DETROIT, MI 48235
Wayne County (313) 993-0200
WALEED OBAID M.D
Internal Medicine
6071 W OUTER DR
DETROIT, MI 48235
Wayne County (313) 966-3250
JAY KINARIWALA
Psychiatry & Neurology (Neurocritical Care)
6071 W OUTER DR
DETROIT, MI 48235
Wayne County (313) 966-1389
MULUKA TAHIR OMAR DO
Student in an Organized Health Care Education/Training Program
6071 W OUTER DR
DETROIT, MI 48235
Wayne County (313) 966-3300
NICKLAS BARA MD
Student in an Organized Health Care Education/Training Program
6071 W OUTER DR
DETROIT, MI 48235
Wayne County (313) 966-3300
DR. ROBERT T MALINOWSKI M.D.
Emergency Medicine
6071 W OUTER DR
DETROIT, MI 48235
Wayne County (313) 966-3300
ZAKLINA DENDOOVEN CRNA
Nurse Anesthetist, Certified Registered
6071 W OUTER DR
DETROIT, MI 48235
Wayne County (952) 442-9770
DR. MATTHEW J GRIFFIN M.D.
Emergency Medicine
6071 W OUTER DR
DETROIT, MI 48235
Wayne County (313) 966-3300

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Bannasch's NPI number?

The NPI number for Kelly Bannasch is 1043330889. It was assigned to this individual provider in the NPPES registry on March 29, 2007.

Where is Kelly Bannasch located?

Kelly Bannasch practices at 6071 W Outer Dr, Detroit, MI 48235. The listed phone number is (313) 966-8559.

What is Kelly Bannasch's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

When was this NPI record last updated?

The NPPES record for Kelly Bannasch was last updated on January 24, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.