Individual
GUSTAVO MIGUEL BANTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2020 W 64TH ST, HIALEAH, FL 33016-2607
(305) 642-5366
(305) 644-6407
Mailing address
8600 NW 41ST ST, DORAL, FL 33166-6202
(305) 642-5366
(305) 644-6407
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
ME112201
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036063412
—
IL
01
—
2136778
CIGNA
AZ
01
—
328075
UNIVERSAL HEALTHCARE
AZ
01
—
4016817
AETNA
AZ
01
—
4500628
BCBS
IL
05
—
776955
—
AZ
01
—
P01137572
RAILROAD MCR
AZ
Enumeration date
07/28/2005
Last updated
07/25/2024
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