Provider Demographics
NPI:1194255521
Name:GANANSKY, RHONDA (MD)
Entity type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:
Last Name:GANANSKY
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:W1383 N BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-4429
Mailing Address - Country:US
Mailing Address - Phone:262-812-7097
Mailing Address - Fax:
Practice Address - Street 1:W1383 N BLOOMFIELD RD
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4429
Practice Address - Country:US
Practice Address - Phone:262-812-7097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31542-20207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology