Provider Demographics
NPI:1194701557
Name:BANSAL, NARENDRA K (MD)
Entity type:Individual
Prefix:
First Name:NARENDRA
Middle Name:K
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:PO BOX 636930
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:513-981-5015
Mailing Address - Fax:
Practice Address - Street 1:770 WEST HIGH STREET
Practice Address - Street 2:SUITE 350
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5901
Practice Address - Country:US
Practice Address - Phone:419-228-8950
Practice Address - Fax:419-224-7904
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038894208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000596292OtherANTHEM
OH1456899OtherCIGNA
OH4466016OtherAETNA
OH0365368Medicaid
OH06145OtherPARAMOUNT ADVANTAGE MEDICAID
OH262788491033OtherCARESOURCE MEDICAID
OH739790OtherBUCKEYE MEDICAID
OH1456899OtherCIGNA
OH0365368Medicaid