Most Relevant Information
Provider Data
| NPI Number: | 1003195306 |
| Provider Name: | ABDUL LATIF BANIRE PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | PA1650 |
Most Important Dates
| Enumeration Date: | 08/04/2011 |
| Last Updated: | 05/24/2021 |
Provider Practice Location
85 N GRAND AVE
FORT THOMAS
KY
410751793
Practice Location Phone/Fax
| Phone: | 8595723618 |
| Fax: | 8595722366 |
Provider Mailing Location
PO BOX 18667
ERLANGER
KY
410180667
Provider Mailing Phone/Fax
| Phone: | 8595723617 |
| Fax: | 8595722366 |