Individual
GEETHA GANESAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3289 N MAYFAIR RD, WAUWATOSA, WI 53222-3203
(414) 771-7900
(414) 607-6336
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
43810
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34352000
—
WI
01
—
P00627752
RR MEDICARE
WI
Enumeration date
07/09/2006
Last updated
09/27/2023
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