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General NPI Number Information
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NPI Number | 1952547507
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Entity Type | Organization
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Legal Business Name | KRISHNA M GANTI MD PA
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Dates
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Enumeration Date | 01/05/2009
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 11373 CORTEZ BLVD SUITE 203
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City | BROOKSVILLE
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State | FL
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Zip | 34613-5414
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Country | US
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Telephone | 352-596-6158
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Fax | 352-596-6186
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Provider Business Mailing Address
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Address Line | 11373 CORTEZ BLVD SUITE 203
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City | BROOKSVILLE
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State | FL
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Zip | 34613-5414
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Country | US
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Telephone | 352-596-6158
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Fax | 352-596-6186
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Authorized Official
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Title or Position | INITIAL OFFICER AND/OR DIRECTOR
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Name | KRISHNA M GANTI
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Credential | MD
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Telephone | 352-596-6158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | ME48997
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License Number State | FL
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