MEDICARE: DR. KEYVAN GANZ DPM

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	213ES0000X	Sports Medicine Podiatrist	POD305010	GA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	1779	TX
3	213ES0000X	Sports Medicine Podiatrist	E5728	CA
4	213ES0000X	Sports Medicine Podiatrist	1779	TX
5	213ES0103X	Foot & Ankle Surgery Podiatrist	0103301393	VA
6	213ES0131X	Foot Surgery Podiatrist	1779	TX

General Provider Information

NPI Number	:	1538104096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEYVAN GANZ DPM

Provider Business Mailing Address
First Line	:	PO BOX 58538
Second Line	:
City	:	WEBSTER
State	:	TX
Zip	:	77598-8538
Country	:	US
Telephone Number	:	281-724-5391
Fax Number	:

Provider Business Practice Location Address
First Line	:	4615 SOUTHWEST FWY STE 1000
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-7108
Country	:	US
Telephone Number	:	346-241-7850
Fax Number	:

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	03/24/2026

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Directions to “ DR. KEYVAN GANZ DPM” Practice Location

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