Healthcare Provider Details

I. General information

NPI: 1063622637
Provider Name (Legal Business Name): HUSSAIN BANU MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E 2ND AVE STE 201
CORALVILLE IA
52241-2225
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-467-2000
  • Fax: 319-467-2814
Mailing address:
  • Phone: 319-467-2000
  • Fax: 319-467-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-37923
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: