Provider Demographics
NPI:1356736433
Name:BANSAL, AMIT
Entity type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:BANSAL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SUNIL
Other - Middle Name:
Other - Last Name:BANSAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SVCS
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-983-3293
Mailing Address - Fax:765-983-3219
Practice Address - Street 1:3130 N. CO RD 25A
Practice Address - Street 2:STE 107
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1337
Practice Address - Country:US
Practice Address - Phone:937-703-6270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-05
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.132643207R00000X
IN01086273A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine