Provider Demographics
NPI:1346219888
Name:RAMACHANDRAN, GANESHAN (DO)
Entity Type:Individual
Prefix:DR
First Name:GANESHAN
Middle Name:
Last Name:RAMACHANDRAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1528
Mailing Address - Country:US
Mailing Address - Phone:574-722-2663
Mailing Address - Fax:574-753-1729
Practice Address - Street 1:1101 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1528
Practice Address - Country:US
Practice Address - Phone:574-722-2663
Practice Address - Fax:574-753-1729
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002611A207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN196290UUUOtherMEDICARE - IN - CMA
IN200445680Medicaid
IN000000731804OtherANTHEM
OH0065592Medicaid
INP01729244OtherRAILROAD MEDICARE
IN000000731804OtherANTHEM
INH91110Medicare UPIN
IN200445680Medicaid