Provider Demographics
NPI:1053530816
Name:BANSAL, ILA (MD)
Entity type:Individual
Prefix:DR
First Name:ILA
Middle Name:
Last Name:BANSAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ILA
Other - Middle Name:
Other - Last Name:JINDAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4301 W MARKHAM
Mailing Address - Street 2:517
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-526-7768
Mailing Address - Fax:501-526-7983
Practice Address - Street 1:4301 W MARKHAM
Practice Address - Street 2:517
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-526-7768
Practice Address - Fax:501-526-7983
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5298207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00407114OtherRAILROAD MEDICARE
ARP00407114OtherRAILROAD MEDICARE