=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861804023
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASHISH GANGASANI MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2014
-----------------------------------------------------
Last Update Date | 05/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6881 BROOK HOLLOW CT
-----------------------------------------------------
City | WEST BLOOMFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48322-5208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-807-2454
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6881 BROOKHOLLOW CT
-----------------------------------------------------
City | WEST BLOOMFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. ASHISH GANGASANI
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 716-807-2454
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0001X
-----------------------------------------------------
Taxonomy Name | Clinical Cardiac Electrophysiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------