Individual
DR. KRISHNA M GANTI
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11373 CORTEZ BLVD, SUITE 203, BROOKSVILLE, FL 34613-5414
(352) 596-6158
(352) 596-6186
Mailing address
11373 CORTEZ BLVD, SUITE 203, BROOKSVILLE, FL 34613-5414
(352) 596-6158
(352) 596-6186
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
048997
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00238
UNIVERSAL HMO
FL
01
—
02407
BLUE CROSS
FL
01
—
09499
WELLCARE HMO
FL
Enumeration date
08/10/2005
Last updated
07/08/2007
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