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General NPI Number Information
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NPI Number | 1629394754
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Entity Type | Individual
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Provider Name | GANESH SIVARAJAN MD
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Gender | Male
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Dates
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Enumeration Date | 04/14/2010
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Last Update Date | 01/15/2024
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Provider Practice Location Address
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Address Line | 14674 W MOUNTAIN VIEW BLVD STE 210
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City | SURPRISE
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State | AZ
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Zip | 85374-2708
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Country | US
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Telephone | 623-546-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 22230 N 55TH ST
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City | PHOENIX
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State | AZ
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Zip | 85054-7157
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Country | US
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Telephone | 630-567-3238
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 51438
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License Number State | AZ
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