Individual
SHYAM SUBRAMANYA GANTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
37 BALL PARK RD, HARLAN, KY 40831-1701
(606) 573-4520
Mailing address
37 BALL PARK RD, HARLAN, KY 40831-1701
(606) 573-4520
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301100882
MI
207RP1001X
Pulmonary Disease Physician
Primary
52668
KY
207RP1001X
Pulmonary Disease Physician
TP281
KY
Other
Enumeration date
08/03/2012
Last updated
09/30/2019
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