Individual
MANISH BANSAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6651 MAIN STREET, LEGACY TOWER E1920, HOUSTON, TX 77005
(832) 826-2789
(832) 826-4287
Mailing address
6651 MAIN STREET, LEGACY TOWER, HOUSTON, TX 77030
(832) 825-5600
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD-43568
IA
2080P0202X
Pediatric Cardiology Physician
MD-43568
IA
2080P0202X
Pediatric Cardiology Physician
Primary
P7066
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1026885970001
—
PA
05
—
3037556
—
OH
Enumeration date
10/17/2007
Last updated
11/05/2018
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