Healthcare Provider Details

I. General information

NPI: 1104744457
Provider Name (Legal Business Name): JESUNIFEMI OLUWASEUN BANIGBE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PLEASANT ST
DES MOINES IA
50309-1406
US

IV. Provider business mailing address

1173 PRAIRIE VIEW DR APT 73206
WEST DES MOINES IA
50266-7608
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-5437
  • Fax:
Mailing address:
  • Phone: 813-953-7877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR14041
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: