Provider Demographics
NPI:1053323089
Name:KANSAL, SUNIL C (MD)
Entity Type:Individual
Prefix:MR
First Name:SUNIL
Middle Name:C
Last Name:KANSAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7255 OLD OAK BLVD
Mailing Address - Street 2:C 302
Mailing Address - City:MIDDLEBURG HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3338
Mailing Address - Country:US
Mailing Address - Phone:440-243-1616
Mailing Address - Fax:440-816-6755
Practice Address - Street 1:7255 OLD OAK BLVD
Practice Address - Street 2:C 302
Practice Address - City:MIDDLEBURG HTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3339
Practice Address - Country:US
Practice Address - Phone:440-243-1616
Practice Address - Fax:440-816-6755
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35046024207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A79971Medicare UPIN