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General NPI Number Information
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NPI Number | 1750970265
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Entity Type | Individual
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Provider Name | VISHAL BANSAL MD
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Gender | Male
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Dates
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Enumeration Date | 01/11/2021
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 200 CLINIC DR
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City | MADISONVILLE
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State | KY
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Zip | 42431-1661
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Country | US
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Telephone | 270-326-6070
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Fax | 270-326-6080
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Provider Business Mailing Address
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Address Line | 200 CLINIC DR
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City | MADISONVILLE
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State | KY
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Zip | 42431-1661
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Country | US
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Telephone | 270-326-6070
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Fax | 270-326-6080
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | BP10072348
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 59917
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License Number State | KY
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