Provider Demographics
NPI:1629229620
Name:GANTA, ASHWIN KUMAR REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHWIN
Middle Name:KUMAR REDDY
Last Name:GANTA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1600 SPECHT POINT RD
Mailing Address - Street 2:SUITE 127
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4311
Mailing Address - Country:US
Mailing Address - Phone:970-493-7733
Mailing Address - Fax:970-493-8745
Practice Address - Street 1:3351 EASTBROOK DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5744
Practice Address - Country:US
Practice Address - Phone:970-493-7733
Practice Address - Fax:970-493-8745
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR0056836207RN0300X
GA069195207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO33970050Medicaid
CODR0056836OtherSTATE LICENSE
CO33970050Medicaid