Provider Demographics
NPI:1477666766
Name:GANACIAS, ADELA RAMIREZ
Entity Type:Individual
Prefix:
First Name:ADELA
Middle Name:RAMIREZ
Last Name:GANACIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADELE
Other - Middle Name:R
Other - Last Name:GANACIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:509 HILLCREST ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-2228
Mailing Address - Country:US
Mailing Address - Phone:913-727-8888
Mailing Address - Fax:
Practice Address - Street 1:550 POPE AVE
Practice Address - Street 2:ATTN: CREDENTIALS OFFICE
Practice Address - City:FORT LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66027-2332
Practice Address - Country:US
Practice Address - Phone:913-684-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24804208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics