Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 2015010142 | MO |
NPI | 1427209725 |
---|---|
Provider Name | Dr. Samiksha Bansal |
First Address | Saint Louis, MO 63124-1217 |
Second Address | Atlanta, GA 30342-1605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2008 |
Last Update Date | 07/07/2016 |