MEDICARE: AMIT BANSAL

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	35.132643	OH
2	207RH0003X	Hematology & Oncology Physician	01086273A	IN

General Provider Information

NPI Number	:	1356736433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIT BANSAL

Provider Business Mailing Address
First Line	:	1100 REID PKWY
Second Line	:	MEDICAL STAFF SVCS
City	:	RICHMOND
State	:	IN
Zip	:	47374-1157
Country	:	US
Telephone Number	:	765-983-3293
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 N. CO RD 25A
Second Line	:	STE 107
City	:	TROY
State	:	OH
Zip	:	45373-1337
Country	:	US
Telephone Number	:	937-703-6270
Fax Number	:

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

Provider Enumeration Date	:	04/05/2015
Last Update Date	:	05/07/2026

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Directions to “ AMIT BANSAL ” Practice Location

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