Individual
DR. RAHUL BANSAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
24B PROFESSIONAL PARK DR, MARYVILLE, IL 62062
(636) 422-0016
(636) 431-3513
Mailing address
24B PROFESSIONAL PARK DR, MARYVILLE, IL 62062-5856
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
036136886
IL
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
036136886
IL
Other
Enumeration date
05/17/2007
Last updated
10/12/2023
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