Provider Demographics
NPI:1942451885
Name:BANSAL, SAURABH KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SAURABH
Middle Name:KUMAR
Last Name:BANSAL
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 1:530 N. E. GLEN OAK AVENUE
Mailing Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61637-0001
Mailing Address - Country:US
Mailing Address - Phone:309-624-9351
Mailing Address - Fax:309-655-7732
Practice Address - Street 1:530 N. E. GLEN OAK AVENUE
Practice Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637-0001
Practice Address - Country:US
Practice Address - Phone:309-624-9351
Practice Address - Fax:309-655-7732
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036128392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine