Healthcare Provider Details

I. General information

NPI: 1861804023
Provider Name (Legal Business Name): ASHISH GANGASANI MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6881 BROOK HOLLOW CT
WEST BLOOMFIELD MI
48322-5208
US

IV. Provider business mailing address

6881 BROOKHOLLOW CT
WEST BLOOMFIELD MI
48322
US

V. Phone/Fax

Practice location:
  • Phone: 716-807-2454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. ASHISH GANGASANI
Title or Position: PHYSICIAN
Credential: M.D
Phone: 716-807-2454