Healthcare Provider Details

I. General information

NPI: 1134569494
Provider Name (Legal Business Name): KAREEM BANNIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 W MAIN ST
MESA AZ
85201-6920
US

IV. Provider business mailing address

3033 N CENTRAL AVE STE 145
PHOENIX AZ
85012-2808
US

V. Phone/Fax

Practice location:
  • Phone: 480-964-2273
  • Fax: 480-718-9477
Mailing address:
  • Phone: 623-583-3001
  • Fax: 623-974-6721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number52640
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number52640
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: