1699736785 NPI number — KIRAN S GANGAHAR MD

Table of content: KIRAN S GANGAHAR MD (NPI 1699736785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699736785 NPI number — KIRAN S GANGAHAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GANGAHAR
Provider First Name:
KIRAN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699736785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6901 N 72ND ST
Provider Second Line Business Mailing Address:
STE 3300N
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-572-3300
Provider Business Mailing Address Fax Number:
402-572-3305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10020 NICHOLAS ST
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-391-5055
Provider Business Practice Location Address Fax Number:
402-391-5053
Provider Enumeration Date:
03/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  17964 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00081365 . This is a "PALMETTO - GBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 47076868513 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1537100 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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