Provider Demographics
NPI:1497859516
Name:KANSAL, RAKESH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAKESH
Middle Name:
Last Name:KANSAL
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 899
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-0899
Mailing Address - Country:US
Mailing Address - Phone:219-663-6011
Mailing Address - Fax:219-662-7214
Practice Address - Street 1:297 W FRANCISCAN LN.
Practice Address - Street 2:SUITE 202
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307
Practice Address - Country:US
Practice Address - Phone:219-663-6011
Practice Address - Fax:219-662-7214
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038984207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100202270Medicaid
IL90000984OtherBCBS OF IL
IN000000088461OtherBCBS OF INDIANA
IN100202270Medicaid
IN628230Medicare PIN