Provider Demographics
NPI:1174648323
Name:BANASIAK, ROSALIE E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSALIE
Middle Name:E
Last Name:BANASIAK
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:12808 NORTH BLACK CANYON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029
Mailing Address - Country:US
Mailing Address - Phone:602-375-1155
Mailing Address - Fax:602-866-9169
Practice Address - Street 1:12808 NORTH BLACK CANYON HIGHWAY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029
Practice Address - Country:US
Practice Address - Phone:602-375-1155
Practice Address - Fax:602-866-9169
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ150372083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine