Healthcare Provider Details

I. General information

NPI: 1275396608
Provider Name (Legal Business Name): GK BANSAL RHEUMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7932 W SAND LAKE RD STE 200
ORLANDO FL
32819-7299
US

IV. Provider business mailing address

12386 STATE ROAD 535
ORLANDO FL
32836-6701
US

V. Phone/Fax

Practice location:
  • Phone: 407-355-7759
  • Fax: 407-355-4987
Mailing address:
  • Phone: 407-355-7759
  • Fax: 407-355-4987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. FARHAN SHAH
Title or Position: MANAGER
Credential:
Phone: 239-444-8185