=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699736785
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIRAN S GANGAHAR MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2006
-----------------------------------------------------
Last Update Date | 10/23/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10020 NICHOLAS ST STE 202
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-391-5055
-----------------------------------------------------
Fax | 402-391-5053
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6901 N 72ND ST STE 3300N
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-572-3300
-----------------------------------------------------
Fax | 402-572-3305
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 17964
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------