Healthcare Provider Details

I. General information

NPI: 1053276378
Provider Name (Legal Business Name): BANAH HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 PILLSBURY AVE S
MINNEAPOLIS MN
55404-2467
US

IV. Provider business mailing address

2011 PILLSBURY AVE S
MINNEAPOLIS MN
55404-2467
US

V. Phone/Fax

Practice location:
  • Phone: 952-239-6790
  • Fax:
Mailing address:
  • Phone: 952-239-6790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN MICHAEL STAPP
Title or Position: OWNER
Credential:
Phone: 952-239-6790