Provider Demographics
NPI:1023296209
Name:BANSAL, DHRUV (MD)
Entity type:Individual
Prefix:DR
First Name:DHRUV
Middle Name:
Last Name:BANSAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12330 METCALF AVE STE 580
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1308
Mailing Address - Country:US
Mailing Address - Phone:816-932-3300
Mailing Address - Fax:816-932-5793
Practice Address - Street 1:12330 METCALF AVE STE 580
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1308
Practice Address - Country:US
Practice Address - Phone:186-932-3300
Practice Address - Fax:816-932-5793
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013016982207RH0003X
IL036-128184207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1023296209Medicaid
ILENROLLEDMedicaid
MO991390110Medicare PIN
IL1023296209Medicaid