Provider Demographics
NPI:1033566112
Name:GANIM, LORI (RT(R)(MR)(ARRT))
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:GANIM
Suffix:
Gender:F
Credentials:RT(R)(MR)(ARRT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4812 MIRAMAR DR UNIT 3202
Mailing Address - Street 2:
Mailing Address - City:MADEIRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-3394
Mailing Address - Country:US
Mailing Address - Phone:765-461-4366
Mailing Address - Fax:
Practice Address - Street 1:10000 BAY PINES BLVD NORTH
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33708
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHR 2547649247100000X
IN3243172471M1202X
FLCRT 83953247100000X
INXT 012010247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist