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1780683656

NPI Code Detail

MEDICARE: MOUNIR F BANOUB MD

MEDICARE: MOUNIR F BANOUB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	4301407542	MI
2	207L00000X	Anesthesiology Physician	77083	GA
3	207L00000X	Anesthesiology Physician	35068550	OH
4	207L00000X	Anesthesiology Physician	036076402	IL
5	207LP2900X	Pain Medicine (Anesthesiology) Physician	35.06855	OH
6	207LP3000X	Pediatric Anesthesiology Physician	35.06855	OH
7	207L00000X	Anesthesiology Physician	ME176033	FL
8	207L00000X	Anesthesiology Physician	2021041427	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780683656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOUNIR F BANOUB MD

Provider Business Mailing Address
First Line	:	770 W GRANADA BLVD STE 101
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5179
Country	:	US
Telephone Number	:	386-231-4519
Fax Number	:	386-368-8927

Provider Business Practice Location Address
First Line	:	301 MEMORIAL MEDICAL PKWY
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5167
Country	:	US
Telephone Number	:	386-231-3147
Fax Number	:	386-231-3695

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	03/02/2026

Similar Medicare Providers

1568591881 — MRS. LUENDA PEARL PERKINS MSN FNP-BC
Practice Location Address:

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DAYTONA BEACH, FL
32117-5167

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Practice Fax: 386-231-1598

1346249315 — STEFAN G HUMPHRIES M.D.
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DAYTONA BEACH, FL
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32117-5167

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1225026503 — LAURA ANNE STONAKER PA.C
Practice Location Address:

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32117-5167

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1972588788 — KATHLEEN ANN WILLIAMS MD
Practice Location Address:

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1629055447 — CINDY J PORTNER DO
Practice Location Address:

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Directions to “ MOUNIR F BANOUB MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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