Healthcare Provider Details

I. General information

NPI: 1629983853
Provider Name (Legal Business Name): KABIR BANSAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N ALVERNON WAY UNIT 101 UNIT 101
TUCSON AZ
85711-1830
US

IV. Provider business mailing address

5755 E RIVER RD APT 3303
TUCSON AZ
85750-6727
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-8888
  • Fax: 520-694-1640
Mailing address:
  • Phone: 816-217-8516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR82570
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: