Provider Demographics
NPI:1093900771
Name:BANSAL-KAPURIA, VIJAYTA G (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYTA
Middle Name:G
Last Name:BANSAL-KAPURIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1860 W WINCHESTER RD STE 106
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5312
Mailing Address - Country:US
Mailing Address - Phone:847-865-7680
Mailing Address - Fax:847-816-6355
Practice Address - Street 1:150 E COOK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2060
Practice Address - Country:US
Practice Address - Phone:847-816-6335
Practice Address - Fax:847-816-6355
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1910282084N0400X
IL0361334252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology