MEDICARE: DR. SRIPRIYA GANESAN

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	208M00000X	Hospitalist Physician	4301087235	MI

General Provider Information

NPI Number	:	1598874612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SRIPRIYA GANESAN

Provider Business Mailing Address
First Line	:	1675 LEAHY ST STE 304B
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49442-5543
Country	:	US
Telephone Number	:	231-728-1695
Fax Number	:

Provider Business Practice Location Address
First Line	:	1675 LEAHY ST STE 304B
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49442-5543
Country	:	US
Telephone Number	:	231-728-1695
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. SRIPRIYA GANESAN ” Practice Location

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