Provider Demographics
NPI:1861500886
Name:OOSTING, GANNA V (MD)
Entity Type:Individual
Prefix:
First Name:GANNA
Middle Name:V
Last Name:OOSTING
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 1:1203 SHOTO RD
Mailing Address - Street 2:
Mailing Address - City:TWO RIVERS
Mailing Address - State:WI
Mailing Address - Zip Code:54241-9180
Mailing Address - Country:US
Mailing Address - Phone:920-901-1597
Mailing Address - Fax:
Practice Address - Street 1:2414 KOHLER MEMORIAL DR
Practice Address - Street 2:AURORA SHEBOYGAN CLINIC/HOSPITALIST GROUP
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3129
Practice Address - Country:US
Practice Address - Phone:920-459-1803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45000207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIH79622OtherCIGNA
WI34342900Medicaid
WI45000OtherTOUCHPOINT
WI390806395002OtherTRICARE
WIH79622OtherCIGNA
WI45000OtherTOUCHPOINT