MEDICARE: SUZANNE M GANO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist
2	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1306002324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE M GANO

Provider Business Mailing Address
First Line	:	6239 S EAST ST STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-2088
Country	:	US
Telephone Number	:	317-791-9031
Fax Number	:

Provider Business Practice Location Address
First Line	:	6239 S EAST ST STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-2088
Country	:	US
Telephone Number	:	317-791-9031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	07/22/2019

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Directions to “ SUZANNE M GANO ” Practice Location

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