KEERTHANA REDDY BANALA (NPI# 1003432816) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003432816 |
| Entity Type | Individual |
| Full Name | KEERTHANA REDDY BANALA |
| Practice Address |
22201 Moross Rd Suite 80 Detroit MI 48236 |
| Practice Telephone | 3133433800 |
| Practice Fax Number | 3133434756 |
| Mailing Telephone | 3133433800 |
| Mailing Fax Number | 3133434756 |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2020-08-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
22201 MOROSS RD SUITE 80 |
| City | DETROIT |
| State | MI |
| Zip Code | 48236 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598760688 | Henry Grady Bone IIi | Internal Medicine | 22201 Moross Rd, Ste 260, Detroit, MI 48236-2175 | 2005-06-16 |
| 1790302396 | Zoheb Backer | Student in an Organized Health Care Education/Training Program | 22201 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-06-30 |
| 1013533918 | Sajithaa Varadarasa | Student in an Organized Health Care Education/Training Program | 22201 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-06-17 |
| 1578188918 | Rida Jamal | Student in an Organized Health Care Education/Training Program | 22201 Moross Rd, Detroit, MI 48236 | 2020-06-11 |
| 1669097952 | Inderpal Singh | Internal Medicine | 22201 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-06-11 |
| 1376168732 | Mehdi Yavari | Student in an Organized Health Care Education/Training Program | 22201 Moross Rd, Detroit, MI 48236 | 2020-06-11 |
| 1548884414 | Krishna Chandra Mahat | Student in an Organized Health Care Education/Training Program | 22201 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-06-05 |
| 1508358540 | Vito Saracino | Internal Medicine | 22201 Moross Rd, Detroit, MI 48236-2169 | 2018-06-05 |
| 1457880718 | Marco Antonio Martinez | Obstetrics & Gynecology | 22201 Moross Rd, Suite 370, Detroit, MI 48236 | 2017-06-08 |
| 1417486234 | Dominic Brink | Internal Medicine | 22201 Moross Rd, 2nd Fl Cath Lab, Detroit, MI 48236 | 2017-06-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093323966 | Khairya Fatouh | Pathology | 22101 Morros Road, Pathology Department, Detroit, Detroit, MI 48236 | 2020-07-16 |
| 1134744998 | Harish Harry Gidda | Internal Medicine | 22201 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-06-08 |
| 1770107443 | Arshan Ali Khan | Internal Medicine | 22101 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-05-29 |
| 1750901658 | Annika Van Wieren | Emergency Medicine | 22101 Moross Road, Emergency Department, Detroit, MI 48236 | 2020-04-21 |
| 1801449483 | Ishaq Azeem Asghar | Student in an Organized Health Care Education/Training Program | 22101 Moross Road, Pathology Department, Detroit, MI 48236 | 2019-07-22 |
| 1295290443 | Ascension St. John Hospital | Dietitian, Registered | 22201 Moross, Ste. 270, Detriot, MI 48236 | 2019-02-01 |
| 1548747413 | Abiodun Adenuga Adefarasin | Pharmacist | 20746 Mack Avenue, Gross Pointe Woods, MI 48236 | 2018-07-24 |
| 1629564042 | Hamza H Khan | Student in an Organized Health Care Education/Training Program | 22201 Moross, Professional Building 2, Suite 70, Detroit, MI 48236 | 2018-07-09 |
| 1235631664 | David Lee Williams | Physical Therapist | 159 Kercheval Avenue, Grosse Pointe Farms, MI 48236 | 2018-03-01 |
| 1164979720 | Memphie Morgan | Licensed Practical Nurse | 91527 Cheshire St., Grosse Pointe, MI 48236 | 2016-09-01 |
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| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013514702 | Leeza Fortner | Student in an Organized Health Care Education/Training Program | 259 Mack Ave Ste 4514, Detroit, MI 48201-2427 | 2020-10-06 |
| 1174132583 | Odei Alayyas | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Boulevard Henry Ford Hospital, Medical Ed, Detroit, MI 48202 | 2020-07-31 |
| 1912516790 | Omar Choudhury | Student in an Organized Health Care Education/Training Program | Henroy Ford Hospital, Medical Education Department ., 2799 W. Grand Boulevard, Detroit, MI 48202-2608 | 2020-07-28 |
| 1659989838 | Saima Sharif | Student in an Organized Health Care Education/Training Program | 4201 St Antoine St 9c-uhc Detroit Education & Research, Detroit, MI 48201 | 2020-07-14 |
| 1609494384 | Praveen Kumar Boddu | Student in an Organized Health Care Education/Training Program | 3901,beaubien, Ste 3t72, Children's Hospital, Detroit, MI 48201 | 2020-07-09 |
| 1932725959 | Devonn Eli Israil | Student in an Organized Health Care Education/Training Program | 4201 Saint Antoine St Rm 2d, Detroit, MI 48201-2153 | 2020-06-25 |
| 1457976292 | Ali Nauman Khan | Student in an Organized Health Care Education/Training Program | Detroit Medical Center-sinai Grace Hospital, 6071 W. Outer Driver, Detroit, MI 48235 | 2020-06-08 |
| 1700400694 | Hassan Imtiaz | Student in an Organized Health Care Education/Training Program | 4201 St. Antoine 8c-uhc, Detroit Medical Center, Detroit, MI 48201 | 2020-06-05 |
| 1598389074 | Alaa Awad Elkarim | Student in an Organized Health Care Education/Training Program | 3901 Beaubien St. 3t72, Detroit, MI 48201 | 2020-06-01 |
| 1891319299 | Jeongyeon Hwang | Student in an Organized Health Care Education/Training Program | 4201 St Antoine Street University Health Center - 8c, Detroit, MI 48201 | 2020-06-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.