Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 036103919 | IL |
N | 207KA0200X | Allergist | 036103919 | IL |
N | 207RA0201X | Internist - Allergy & Immunology | 036103919 | IL |
N | 2080P0201X | Pediatric Allergist | 036103919 | IL |
NPI | 1811970486 |
---|---|
Provider Name | Dr. Priya J Bansal |
First Address | Naperville, IL 60540-7352 |
Second Address | Saint Charles, IL 60174 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2005 |
Last Update Date | 05/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036103919 | (05) | IL |
I08801 | (02) | IL |