MEDICARE: DR. RAJENDRA K BANSAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME0049954	FL
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	ME0049954	FL
3	208M00000X	Hospitalist Physician	ME0049954	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285627885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAJENDRA K BANSAL MD

Provider Business Mailing Address
First Line	:	875 MILITARY TRL
Second Line	:	SUITE 200
City	:	JUPITER
State	:	FL
Zip	:	33458-5700
Country	:	US
Telephone Number	:	561-746-2411
Fax Number	:	561-354-0012

Provider Business Practice Location Address
First Line	:	875 MILITARY TRL
Second Line	:	SUITE 200
City	:	JUPITER
State	:	FL
Zip	:	33458-5700
Country	:	US
Telephone Number	:	561-746-2411
Fax Number	:	561-354-0012

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	07/28/2008

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