Individual
KIMBERLY GANGWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5177 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
CERT 92231
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000996847
ANTHEM PROVIDER NUMBER
IN
Enumeration date
02/23/2016
Last updated
03/30/2016
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