Provider Demographics
NPI:1659455830
Name:SUDESH BANAJI, MD, PLLC
Entity Type:Organization
Organization Name:SUDESH BANAJI, MD, PLLC
Other - Org Name:INTERNAL MEDICINE OF FORREST CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BANAJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-630-2233
Mailing Address - Street 1:332 E COOK ST
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-2830
Mailing Address - Country:US
Mailing Address - Phone:870-630-2233
Mailing Address - Fax:870-630-2224
Practice Address - Street 1:332 E COOK ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2830
Practice Address - Country:US
Practice Address - Phone:870-630-2233
Practice Address - Fax:870-630-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F219OtherAR BCBS
AR5L309OtherAR BCBS
AR138381001Medicaid
AR5L309Medicare ID - Type UnspecifiedAR MEDICARE
AR5L309OtherAR BCBS