Provider Demographics
NPI:1093756793
Name:GASTROENTEROLOGY FOR KIDS
Entity Type:Organization
Organization Name:GASTROENTEROLOGY FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAYSHREE
Authorized Official - Middle Name:V
Authorized Official - Last Name:GANATRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-689-5100
Mailing Address - Street 1:9800 S HEALTHPARK DR
Mailing Address - Street 2:STE 102
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-7603
Mailing Address - Country:US
Mailing Address - Phone:239-689-5100
Mailing Address - Fax:239-689-5107
Practice Address - Street 1:9800 S HEALTHPARK DR
Practice Address - Street 2:STE 102
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-7603
Practice Address - Country:US
Practice Address - Phone:239-689-5100
Practice Address - Fax:239-689-5107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty