Provider Demographics
NPI:1811970486
Name:BANSAL, PRIYA J (MD,)
Entity type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:J
Last Name:BANSAL
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1187 CLEANDER CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7352
Mailing Address - Country:US
Mailing Address - Phone:630-247-4304
Mailing Address - Fax:
Practice Address - Street 1:2435 DEAN ST UNIT C
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-4827
Practice Address - Country:US
Practice Address - Phone:630-584-6127
Practice Address - Fax:630-584-6070
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103919207KA0200X, 207RA0201X, 2080P0201X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103919Medicaid
ILK07563Medicare ID - Type UnspecifiedMEDICARE NUMBER