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General NPI Number Information
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NPI Number | 1275396608
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Entity Type | Organization
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Legal Business Name | GK BANSAL RHEUMATOLOGY PLLC
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Dates
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Enumeration Date | 01/30/2024
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 7932 W SAND LAKE RD STE 200
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City | ORLANDO
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State | FL
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Zip | 32819-7299
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Country | US
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Telephone | 407-355-7759
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Fax | 407-355-4987
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Provider Business Mailing Address
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Address Line | 12386 STATE ROAD 535
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City | ORLANDO
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State | FL
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Zip | 32836-6701
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Country | US
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Telephone | 407-355-7759
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Fax | 407-355-4987
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Authorized Official
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Title or Position | MANAGER
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Name | MR. FARHAN SHAH
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Credential |
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Telephone | 239-444-8185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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