Individual
ABDUL LATIF BANIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
85 N GRAND AVE, FORT THOMAS, KY 41075-1793
(859) 572-3618
(859) 572-2366
Mailing address
PO BOX 18667, ERLANGER, KY 41018-0667
(859) 572-3617
(859) 572-2366
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA1650
IN
363A00000X
Physician Assistant
Primary
PA1650
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300047753
—
IN
05
—
7100229590
—
KY
Enumeration date
08/04/2011
Last updated
05/24/2021
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