Provider Demographics
NPI:1174898498
Name:SUDHA BANSAL MD PC
Entity type:Organization
Organization Name:SUDHA BANSAL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANSAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-264-5820
Mailing Address - Street 1:PO BOX 1476
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-7476
Mailing Address - Country:US
Mailing Address - Phone:517-264-5820
Mailing Address - Fax:517-264-0311
Practice Address - Street 1:415 MILL RD
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1764
Practice Address - Country:US
Practice Address - Phone:517-264-5820
Practice Address - Fax:517-264-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty