MEDICARE: BANKAI PHYSICIANS LLC

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	208100000X	Physical Medicine & Rehabilitation Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1982145157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BANKAI PHYSICIANS LLC

Provider Business Mailing Address
First Line	:	PO BOX 1684
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71165-1684
Country	:	US
Telephone Number	:	318-424-6004
Fax Number	:	866-276-8064

Provider Business Practice Location Address
First Line	:	1111 LINE AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-3841
Country	:	US
Telephone Number	:	318-716-4770
Fax Number	:	318-716-4791

Authorized Official
Title or Position	:	OWNER
Name	:	ADAM MOSSALLATI
Credential	:	MD
Telephone Number	:	304-203-5754

Provider Enumeration Date	:	03/20/2017
Last Update Date	:	11/21/2022

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Directions to “BANKAI PHYSICIANS LLC ” Practice Location

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