Provider Demographics
NPI:1780089094
Name:RAKESH KANSAL MD PC
Entity type:Organization
Organization Name:RAKESH KANSAL MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:KANSAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-663-6011
Mailing Address - Street 1:297 W FRANCISCAN DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-4858
Mailing Address - Country:US
Mailing Address - Phone:219-663-6011
Mailing Address - Fax:219-662-7214
Practice Address - Street 1:297 W FRANCISCAN DR
Practice Address - Street 2:SUITE 202
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4858
Practice Address - Country:US
Practice Address - Phone:219-663-6011
Practice Address - Fax:219-662-7214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038984174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201389000AMedicaid
IN201389000AMedicaid