Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 35036799 | OH |
NPI | 1033266804 |
---|---|
Provider Name | Dr. Surinder K Bansal |
First Address | Lima, OH 45801-4653 |
Second Address | Lima, OH 45801-4653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0350883 | (05) | OH |
A75126 | (02) | OH |
AB5948926 | DEA (01) | OH |