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General NPI Number Information
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NPI Number | 1619731320
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Entity Type | Organization
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Legal Business Name | GANESHA INSTITUTE OF NEUROLOGY AND PSYCHIATRY SC
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Dates
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Enumeration Date | 02/13/2024
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 4600 GREEN BAY RD
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City | KENOSHA
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State | WI
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Zip | 53144-1719
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Country | US
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Telephone | 262-286-1860
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14545
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City | BELFAST
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State | ME
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Zip | 04915-4038
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Country | US
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Telephone | 847-816-6335
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LORI A SMITH
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Credential |
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Telephone | 847-816-6441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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