Provider Demographics
NPI:1790825768
Name:GANGE, STEVEN N (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:N
Last Name:GANGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4252 S. HIGHLAND DR.
Mailing Address - Street 2:#200
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84124
Mailing Address - Country:US
Mailing Address - Phone:801-993-1800
Mailing Address - Fax:801-993-1699
Practice Address - Street 1:4252 HIGHLAND DR
Practice Address - Street 2:#200
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84124-2670
Practice Address - Country:US
Practice Address - Phone:801-993-1800
Practice Address - Fax:801-993-1699
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT3226261205208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTC68665Medicare UPIN
UT005519501Medicare ID - Type Unspecified