Provider Demographics
NPI:1558677690
Name:SEHGAL, BANTOO (MD)
Entity type:Individual
Prefix:DR
First Name:BANTOO
Middle Name:
Last Name:SEHGAL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 12TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2519
Mailing Address - Country:US
Mailing Address - Phone:214-631-9881
Mailing Address - Fax:694-822-5264
Practice Address - Street 1:800 12TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2519
Practice Address - Country:US
Practice Address - Phone:214-631-9881
Practice Address - Fax:469-482-2526
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2025-05-03
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