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General NPI Number Information
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NPI Number | 1689863425
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Entity Type | Individual
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Provider Name | MANISH BANSAL MD
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Gender | Male
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 11/05/2018
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Provider Practice Location Address
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Address Line | 6651 MAIN STREET LEGACY TOWER E1920
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City | HOUSTON
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State | TX
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Zip | 77005
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Country | US
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Telephone | 832-826-2789
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Fax | 832-826-4287
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Provider Business Mailing Address
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Address Line | 6651 MAIN STREET LEGACY TOWER
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City | HOUSTON
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State | TX
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Zip | 77030
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Country | US
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Telephone | 832-825-5600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | MD-43568
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD-43568
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | P7066
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License Number State | TX
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