Provider Demographics
NPI:1386890382
Name:ABE BANSALI M.D PC
Entity type:Organization
Organization Name:ABE BANSALI M.D PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLO PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:ABE
Authorized Official - Middle Name:
Authorized Official - Last Name:BANSALI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:269-962-3701
Mailing Address - Street 1:363 FREMONT STREET
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017
Mailing Address - Country:US
Mailing Address - Phone:269-962-3701
Mailing Address - Fax:269-962-8838
Practice Address - Street 1:363 FREMONT STREET
Practice Address - Street 2:SUITE 106
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017
Practice Address - Country:US
Practice Address - Phone:269-962-3701
Practice Address - Fax:269-962-8838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43031097207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1090352Medicaid
MI0131240OtherBCBSM
MI1090352Medicaid
MN0131240Medicare PIN