MEDICARE: ASHISH GANGASANI MD PLLC

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	207RC0001X	Clinical Cardiac Electrophysiology Physician		MI

General Provider Information

NPI Number	:	1861804023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHISH GANGASANI MD PLLC

Provider Business Mailing Address
First Line	:	6881 BROOKHOLLOW CT
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6881 BROOK HOLLOW CT
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-5208
Country	:	US
Telephone Number	:	716-807-2454
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ASHISH GANGASANI
Credential	:	M.D
Telephone Number	:	716-807-2454

Provider Enumeration Date	:	05/22/2014
Last Update Date	:	05/22/2014

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