Individual
DR. SIDDHARTHA GANGULY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6445 MAIN STREET, OPC FLOOR 24, HOUSTON, TX 77030
(713) 441-9948
Mailing address
6445 MAIN STREET, OPC FLOOR 24, HOUSTON, TX 77030
(713) 441-9948
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
Primary
25693
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100450610A
—
KS
05
—
208433904
—
MO
01
—
32125027
BCBS KC
MO
01
—
405970
FIRSTGUARD
KS
Enumeration date
10/02/2006
Last updated
10/01/2021
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