Provider Demographics
NPI:1194710533
Name:GANIO, CARL (DPM)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:GANIO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 17TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5518
Mailing Address - Country:US
Mailing Address - Phone:772-770-9127
Mailing Address - Fax:772-770-1530
Practice Address - Street 1:611 17TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5518
Practice Address - Country:US
Practice Address - Phone:772-770-9127
Practice Address - Fax:772-770-1530
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-0001781213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1205600001Medicare NSC
FL65038CMedicare PIN
FLT84347Medicare UPIN