Healthcare Provider Details

I. General information

NPI: 1932053774
Provider Name (Legal Business Name): MICHAEL GANZORIG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MOSAIC COURT
ST JOSEPH MO
64506
US

IV. Provider business mailing address

4424 EUCLID AVE APT 1B
ROLLING MEADOWS IL
60008-1942
US

V. Phone/Fax

Practice location:
  • Phone: 816-235-1808
  • Fax:
Mailing address:
  • Phone: 847-530-3118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: