Individual
SHIVENDRA BANSAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3315 KETHLEY RD, SHAWNEE, OK 74804
(405) 273-5801
(405) 878-3794
Mailing address
3315 KETHLEY RD, SHAWNEE, OK 74804-9638
(405) 273-5801
(405) 878-3794
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
32293
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/13/2016
Last updated
06/04/2019
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