MEDICARE: DR. ASHWIN KUMAR REDDY GANTA 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	207RN0300X	Nephrology Physician	DR0056836	CO
2	207RN0300X	Nephrology Physician	069195	GA

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
2	DR0056836	OTHER	CO	STATE LICENSE

General Provider Information

NPI Number	:	1629229620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHWIN KUMAR REDDY GANTA M.D

Provider Business Mailing Address
First Line	:	1600 SPECHT POINT RD
Second Line	:	SUITE 127
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4311
Country	:	US
Telephone Number	:	970-493-7733
Fax Number	:	970-493-8745

Provider Business Practice Location Address
First Line	:	3351 EASTBROOK DR STE 100
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5744
Country	:	US
Telephone Number	:	970-493-7733
Fax Number	:	970-493-8745

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

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	03/26/2024

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Directions to “ DR. ASHWIN KUMAR REDDY GANTA M.D” Practice Location

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