Provider Demographics
NPI:1417907056
Name:BANOONI, FIROOZ (MD)
Entity Type:Individual
Prefix:
First Name:FIROOZ
Middle Name:
Last Name:BANOONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 W 13 MILE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073
Mailing Address - Country:US
Mailing Address - Phone:248-288-2230
Mailing Address - Fax:248-288-5450
Practice Address - Street 1:3535 W 13 MILE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073
Practice Address - Country:US
Practice Address - Phone:248-288-2230
Practice Address - Fax:248-288-5450
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFB032283207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI100209OtherGREAT LAKES HEALTH PLAN
MI212791OtherOMNI CARE
MIB2900OtherM-CARE
MIB45518OtherHEALTH ALLIANCE PLAN
MI127194OtherCARE CHOICES
MI4120590Medicaid
MI0630040OtherBLUE CARE NETWORK
MI0630040OtherBCBS OF MICHIGAN
MI1223060008OtherWELLNESS PLAN
MI0630040OtherBCBS OF MICHIGAN
MI4120590Medicaid