Provider Demographics
NPI:1316926181
Name:GANSKE, JOHN G (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:GANSKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GREG
Other - Middle Name:
Other - Last Name:GANSKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6000 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8203
Mailing Address - Country:US
Mailing Address - Phone:515-265-4414
Mailing Address - Fax:515-265-4486
Practice Address - Street 1:6000 UNIVERSITY AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8203
Practice Address - Country:US
Practice Address - Phone:515-265-4414
Practice Address - Fax:515-265-4486
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24063208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1215087Medicaid
IAA02411Medicare UPIN
IA1215087Medicaid