Provider Demographics
NPI:1538487343
Name:BANNA, HADELE (MD)
Entity type:Individual
Prefix:
First Name:HADELE
Middle Name:
Last Name:BANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 METROHEALTH DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1900
Mailing Address - Country:US
Mailing Address - Phone:216-778-5394
Mailing Address - Fax:
Practice Address - Street 1:8404 PRESTON RD STE 208
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3332
Practice Address - Country:US
Practice Address - Phone:440-413-4813
Practice Address - Fax:888-435-5331
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ1086207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX449510OtherMEDICARE