Provider Demographics
NPI:1699926824
Name:BANSAL, ANISH (MD)
Entity type:Individual
Prefix:
First Name:ANISH
Middle Name:
Last Name:BANSAL
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 HURLEY PLZ
Mailing Address - Street 2:RADIOLOGY DEPARTMENT
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-5902
Mailing Address - Country:US
Mailing Address - Phone:810-262-4761
Mailing Address - Fax:810-262-4871
Practice Address - Street 1:1 HURLEY PLZ
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5902
Practice Address - Country:US
Practice Address - Phone:810-262-4761
Practice Address - Fax:810-262-4871
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2024-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA404222085R0202X, 2085R0204X
TXU61162085R0202X
MI43011022612085R0202X, 2085R0204X
IAR-83152085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB56112038Medicare PIN
MIB54778036Medicare PIN