Provider Demographics
NPI:1184799124
Name:BANSIL, SANDEEP K (MD)
Entity type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:K
Last Name:BANSIL
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 1:8333 IOWA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4994
Mailing Address - Country:US
Mailing Address - Phone:562-923-1211
Mailing Address - Fax:562-923-3151
Practice Address - Street 1:8333 IOWA ST STE 200
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4994
Practice Address - Country:US
Practice Address - Phone:562-923-1211
Practice Address - Fax:562-923-3151
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74966207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A749660Medicaid
CAWA74966AMedicare ID - Type Unspecified
CA00A749660Medicaid