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Individual

DR. MAHAMUNI GANESAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.,

Contact information

Practice address
23 W PERRY ST, TIFFIN, OH 44883-2243
(419) 448-4171
(419) 448-5551
Mailing address
23 W PERRY ST, TIFFIN, OH 44883-2243
(419) 448-4171
(419) 448-5551

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35-034118
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0006237
CHAMPUS
05
0314163
OH
01
31-1020375-00
WORKERS COMP.NO.
OH
01
35-034118
OHIO STATE MEDICAL BOARD
OH
Enumeration date
11/09/2006
Last updated
03/07/2023
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