Provider Demographics
NPI:1386648749
Name:ANSARI, BILAL (MD)
Entity Type:Individual
Prefix:DR
First Name:BILAL
Middle Name:
Last Name:ANSARI
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 746092
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6092
Mailing Address - Country:US
Mailing Address - Phone:574-334-5400
Mailing Address - Fax:574-237-1348
Practice Address - Street 1:5340 HOLY CROSS PKWY
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1470
Practice Address - Country:US
Practice Address - Phone:574-237-1328
Practice Address - Fax:574-968-9442
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081171207RH0003X
IN01051238A207RX0202X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200402780AMedicaid
MI10-4405482Medicaid
MI10-4405482Medicaid
INH77892Medicare UPIN
IN216950LMedicare PIN