Provider Demographics
NPI:1184886533
Name:BANNON, KRISTA MAUREEN (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:MAUREEN
Last Name:BANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:MAUREEN
Other - Last Name:ZAYOUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 RIVERFRONT DR
Mailing Address - Street 2:UNIT 11B
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-4516
Mailing Address - Country:US
Mailing Address - Phone:312-282-3182
Mailing Address - Fax:
Practice Address - Street 1:441 S LIVERNOIS RD STE 260
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2593
Practice Address - Country:US
Practice Address - Phone:248-855-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092722208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery