Provider Demographics
NPI:1700185980
Name:DEVENDRA, GANESH
Entity Type:Individual
Prefix:
First Name:GANESH
Middle Name:
Last Name:DEVENDRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2463 OVERLOOK RD
Mailing Address - Street 2:#9
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-5621
Mailing Address - Country:US
Mailing Address - Phone:818-324-0053
Mailing Address - Fax:
Practice Address - Street 1:2463 OVERLOOK RD
Practice Address - Street 2:#9
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-5621
Practice Address - Country:US
Practice Address - Phone:818-324-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-27
Last Update Date:2011-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program