Organization
MUSSA BANISADRE MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MUSSA BANISADRE MD INC (MD OWNER)
(209) 524-7000
Entity
Organization
Contact information
Practice address
1325 MELROSE AVE, SUITE A, MODESTO, CA 95350-5581
(209) 527-5601
Mailing address
1325 MELROSE AVE, SUITE A, MODESTO, CA 95350-5581
(209) 527-5601
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
A38740
CA
Other
Enumeration date
04/23/2008
Last updated
07/11/2008
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