Individual
DR. HEIDI L BANISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
PO BOX 11447, GLENDALE, AZ 85318-1447
(623) 773-2848
(623) 773-0370
Mailing address
18555 N. 79TH AVE, B108, GLENDAL, AZ 85308
(623) 773-2848
(623) 773-0370
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
30245
AZ
Other
Enumeration date
09/13/2005
Last updated
10/17/2019
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