Provider Demographics
NPI:1063405751
Name:GANAPES, CONSTANCE M (MD)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:M
Last Name:GANAPES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W LAYTON AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-5420
Mailing Address - Country:US
Mailing Address - Phone:414-282-2006
Mailing Address - Fax:414-281-8704
Practice Address - Street 1:2500 W LAYTON AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-5420
Practice Address - Country:US
Practice Address - Phone:414-282-2006
Practice Address - Fax:414-281-8704
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30385300Medicaid
WI30385300Medicaid
WI000402475Medicare ID - Type Unspecified