Provider Demographics
NPI:1780683656
Name:BANOUB, MOUNIR F (MD)
Entity Type:Individual
Prefix:
First Name:MOUNIR
Middle Name:F
Last Name:BANOUB
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 1:2817 SPRING WATER DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1369
Mailing Address - Country:US
Mailing Address - Phone:419-345-4449
Mailing Address - Fax:
Practice Address - Street 1:2213 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2603
Practice Address - Country:US
Practice Address - Phone:419-251-4715
Practice Address - Fax:419-251-6876
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA77083207L00000X
MO2021041427207L00000X
MI4301407542207L00000X
IL036076402207L00000X
OH35068550207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0186543Medicaid
OH0783012Medicare PIN
OHG04111Medicare UPIN
OH0783013Medicare PIN
OH050073435Medicare PIN
OH0783014Medicare PIN