Provider Demographics
NPI:1447420427
Name:GANICK, SAMANTHA J (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:J
Last Name:GANICK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2351 CONNECTICUT AVE S STE 200
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2477
Mailing Address - Country:US
Mailing Address - Phone:320-259-1411
Mailing Address - Fax:320-259-8967
Practice Address - Street 1:2351 CONNECTICUT AVE S STE 200
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2477
Practice Address - Country:US
Practice Address - Phone:320-259-1411
Practice Address - Fax:320-259-8967
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA253902208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology