Provider Demographics
NPI:1710081914
Name:BANKI, FARZANEH (MD)
Entity Type:Individual
Prefix:
First Name:FARZANEH
Middle Name:
Last Name:BANKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11914 ASTORIA BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6064
Mailing Address - Country:US
Mailing Address - Phone:713-486-1100
Mailing Address - Fax:281-464-3478
Practice Address - Street 1:11914 ASTORIA BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6064
Practice Address - Country:US
Practice Address - Phone:713-486-1100
Practice Address - Fax:281-464-3478
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044652208G00000X
CAA65397208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABM713ZMedicare PIN
CAWA65397AMedicare PIN
CA00A653970OtherBLUE SHIELD PROV NUMBER
CAP00123990OtherMEDICARE RAILROAD NUMBER
CA00A653970Medicaid