Provider Demographics
NPI:1699736785
Name:GANGAHAR, KIRAN S (MD)
Entity type:Individual
Prefix:
First Name:KIRAN
Middle Name:S
Last Name:GANGAHAR
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 1:6901 N 72ND ST
Mailing Address - Street 2:STE 3300N
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122
Mailing Address - Country:US
Mailing Address - Phone:402-572-3300
Mailing Address - Fax:402-572-3305
Practice Address - Street 1:10020 NICHOLAS ST
Practice Address - Street 2:STE 202
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114
Practice Address - Country:US
Practice Address - Phone:402-391-5055
Practice Address - Fax:402-391-5053
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17964207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00081365OtherPALMETTO - GBA
NE47076868513Medicaid
IA1537100Medicaid
E60518Medicare UPIN
277080Medicare ID - Type Unspecified