Provider Demographics
NPI:1629394754
Name:SIVARAJAN, GANESH (MD)
Entity Type:Individual
Prefix:DR
First Name:GANESH
Middle Name:
Last Name:SIVARAJAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22230 N 55TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-7157
Mailing Address - Country:US
Mailing Address - Phone:630-567-3238
Mailing Address - Fax:
Practice Address - Street 1:14674 W MOUNTAIN VIEW BLVD STE 210
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2708
Practice Address - Country:US
Practice Address - Phone:623-546-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51438208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology