Organization
KRISHNA M GANTI MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISHNA M GANTI MD (INITIAL OFFICER AND/OR DIRECTOR)
(352) 596-6158
Entity
Organization
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
207Y00000X
Otolaryngology Physician
Primary
ME48997
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02407
BLUE CROSS FLORIDA
FL
01
—
02407Y
MEDICARE INDIVIDUAL PTAN
FL
01
—
09499
WELLCARE
FL
01
—
1063413128
MEDICARE INDIVIDUAL NPI
FL
01
—
1952547507
MEDICARE GROUP NPI
FL
01
—
40001752
RAILROAD MEDICARE
FL
05
—
57664600
—
FL
01
—
BJ359
MEDICARE GROUP PTAN
FL
Enumeration date
01/05/2009
Last updated
07/29/2009
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