Shivendra Bansal, M.D.
Family Medicine in Shawnee, OK. Individual provider (NPI-1).
NPI number1144679952
StatusActive
Last updated in NPPESJun 4, 2019
Details
- NPI
- 1144679952
- Entity type
- Individual (NPI-1)
- Name
- Shivendra Bansal
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 13, 2016
- Last updated
- Jun 4, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 32293 | OK | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
3315 Kethley RdShawnee, OK 74804
Phone 405-273-5801 · Fax 405-878-3794
Mailing address
3315 Kethley RdShawnee, OK 74804-9638
Phone 405-273-5801 · Fax 405-878-3794
Other practice locations
900 Ne 10th St
Oklahoma City, OK 73104-5420
Oklahoma City, OK 73104-5420
Phone 405-271-2230
900 Ne 10th St
Oklahoma City, OK 73104-5420
Oklahoma City, OK 73104-5420
Phone 405-271-2230
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