MEDICARE: MR. SUNIL C KANSAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35046024	OH

General Provider Information

NPI Number	:	1053323089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SUNIL C KANSAL MD

Provider Business Mailing Address
First Line	:	7255 OLD OAK BLVD
Second Line	:	C 302
City	:	MIDDLEBURG HTS
State	:	OH
Zip	:	44130-3338
Country	:	US
Telephone Number	:	440-243-1616
Fax Number	:	440-816-6755

Provider Business Practice Location Address
First Line	:	7255 OLD OAK BLVD
Second Line	:	C 302
City	:	MIDDLEBURG HTS
State	:	OH
Zip	:	44130-3339
Country	:	US
Telephone Number	:	440-243-1616
Fax Number	:	440-816-6755

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	05/19/2021

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