1386890382 NPI number — ABE BANSALI M.D PC

Table of content: (NPI 1386890382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386890382 NPI number — ABE BANSALI M.D PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABE BANSALI M.D PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ATMARAM BHAIDAS BHANSALI M.D P.C
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386890382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
363 FREMONT STREET
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
BATTLE CREEK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-962-3701
Provider Business Mailing Address Fax Number:
269-962-8838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
363 FREMONT STREET
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-962-3701
Provider Business Practice Location Address Fax Number:
269-962-8838
Provider Enumeration Date:
08/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BANSALI
Authorized Official First Name:
ABE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/SOLO PRACTICE
Authorized Official Telephone Number:
269-962-3701

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  43031097 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1090352 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0131240 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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