Healthcare Provider Details

I. General information

NPI: 1558677690
Provider Name (Legal Business Name): BANTOO SEHGAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 05/03/2025
Certification Date: 05/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 12TH AVE STE 200
FORT WORTH TX
76104-2519
US

IV. Provider business mailing address

800 12TH AVE STE 200
FORT WORTH TX
76104-2519
US

V. Phone/Fax

Practice location:
  • Phone: 214-631-9881
  • Fax: 469-482-2526
Mailing address:
  • Phone: 214-631-9881
  • Fax: 694-822-5264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number249831-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberPT 12022
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA112987
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberR0125
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: