Provider Demographics
NPI:1710947346
Name:GANSKE, CORRINE M (MD)
Entity Type:Individual
Prefix:
First Name:CORRINE
Middle Name:M
Last Name:GANSKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 E UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2304
Mailing Address - Country:US
Mailing Address - Phone:515-265-4211
Mailing Address - Fax:515-309-5993
Practice Address - Street 1:840 E UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2304
Practice Address - Country:US
Practice Address - Phone:515-265-4211
Practice Address - Fax:515-309-5993
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-24154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1710947346Medicaid
IA0218065Medicaid
IA0218065Medicaid
IA21806Medicare PIN
IAA02491Medicare UPIN
IA71926092Medicare PIN