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General NPI Number Information
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NPI Number | 1467456848
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Entity Type | Individual
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Provider Name | GANESH RAM PA
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Gender | Male
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 1400 BELLINGER ST
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City | EAU CLAIRE
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State | WI
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Zip | 54703-5222
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Country | US
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Telephone | 715-838-5222
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Fax |
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Provider Business Mailing Address
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Address Line | 200 1ST ST SW
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City | ROCHESTER
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State | MN
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Zip | 55905-0001
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Country | US
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Telephone | 507-284-2511
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 950
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 950
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 2005034534
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 950
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License Number State | WI
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