Basic Information
| Provider Information | |||||||||
| NPI: | 1962523381 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANSAL | ||||||||
| FirstName: | ARVIND | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2401 DEMERS AVE | ||||||||
| Address2: | |||||||||
| City: | GRAND FORKS | ||||||||
| State: | ND | ||||||||
| PostalCode: | 58201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017801891 | ||||||||
| FaxNumber: | 7017801942 | ||||||||
| Practice Location | |||||||||
| Address1: | 166 PASADENA DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405032974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592780319 | ||||||||
| FaxNumber: | 8592779699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 12/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 054461 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 054461 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RG0300X | 054461 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207RC0200X | 52641 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207R00000X | 10454 | ND | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 054461 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 10454 | ND | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.