Provider Demographics
NPI:1548293442
Name:BANSAL, PARVESH K (MD)
Entity type:Individual
Prefix:
First Name:PARVESH
Middle Name:K
Last Name:BANSAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PINE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3170
Mailing Address - Country:US
Mailing Address - Phone:321-676-6000
Mailing Address - Fax:321-676-7000
Practice Address - Street 1:1400 PINE ST
Practice Address - Street 2:SUITE A
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3170
Practice Address - Country:US
Practice Address - Phone:321-676-6000
Practice Address - Fax:321-676-7000
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50550207RC0200X, 207RP1001X
FLME 50550207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046576300Medicaid
FL03989YOtherINDIVIDUAL PTAN
BB0723002OtherDEA
D69030Medicare UPIN
FL046576300Medicaid