Provider Demographics
NPI:1255441044
Name:RADHEY S. BANSAL, MD. INC
Entity type:Organization
Organization Name:RADHEY S. BANSAL, MD. INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RADHEY
Authorized Official - Middle Name:SHIAM
Authorized Official - Last Name:BANSAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-725-7793
Mailing Address - Street 1:1230 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-2204
Mailing Address - Country:US
Mailing Address - Phone:661-725-7793
Mailing Address - Fax:660-725-0595
Practice Address - Street 1:1230 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-2204
Practice Address - Country:US
Practice Address - Phone:661-725-7793
Practice Address - Fax:660-725-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0087300Medicaid
CAZZZ17879ZMedicare PIN