Healthcare Provider Details

I. General information

NPI: 1508057621
Provider Name (Legal Business Name): RICHARD W GANZHORN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 OSBORN BLVD
SAULT S MARIE MI
49783-1850
US

IV. Provider business mailing address

511 OSBORN BLVD
SAULT S MARIE MI
49783-1850
US

V. Phone/Fax

Practice location:
  • Phone: 906-632-4740
  • Fax: 906-632-6505
Mailing address:
  • Phone: 906-632-4740
  • Fax: 906-632-6505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. RICHARD W GANZHORN
Title or Position: PRESIDENT
Credential: MD
Phone: 906-632-4740