MEDICARE: GEORGE S. GANESAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	6402	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457332538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE S. GANESAN M.D.

Provider Business Mailing Address
First Line	:	6670 S. TANAYA WAY
Second Line	:	SUITE 180
City	:	LAS VEGAS
State	:	NV
Zip	:	89113
Country	:	US
Telephone Number	:	702-369-4999
Fax Number	:	702-369-2993

Provider Business Practice Location Address
First Line	:	3201 S MARYLAND PKWY
Second Line	:	SUITE 406
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2441
Country	:	US
Telephone Number	:	702-369-4999
Fax Number	:	702-369-2993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	04/24/2014

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Directions to “ GEORGE S. GANESAN M.D.” Practice Location

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