Provider Demographics
NPI:1558677690
Name:SEHGAL, BANTOO (MD)
Entity Type:Individual
Prefix:DR
First Name:BANTOO
Middle Name:
Last Name:SEHGAL
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 1:2600 E SOUTHLAKE BLVD STE 120-177
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6634
Mailing Address - Country:US
Mailing Address - Phone:214-631-9881
Mailing Address - Fax:469-466-6101
Practice Address - Street 1:2120 N MACARTHUR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2260
Practice Address - Country:US
Practice Address - Phone:214-631-9881
Practice Address - Fax:972-438-2077
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249831-1207XX0005X
NDPT 12022207XX0005X
CAA112987207XX0005X
TXR0125207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND16135Medicaid
NDN716929Medicare PIN