Healthcare Provider Details

I. General information

NPI: 1609909282
Provider Name (Legal Business Name): WILLIAM F. GANZ MD FACS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 N MERRIT CREEK LOOP SUITE A
COEUR D ALENE ID
83814-4960
US

IV. Provider business mailing address

2236 N MERRIT CREEK LOOP SUITE A
COEUR D ALENE ID
83814-4960
US

V. Phone/Fax

Practice location:
  • Phone: 208-664-5467
  • Fax: 208-765-4696
Mailing address:
  • Phone: 208-664-5467
  • Fax: 208-765-4696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberM8313
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. LUANN GANZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 208-664-5467