Provider Demographics
NPI:1013090901
Name:GANZ ALLERGY & ASTHMA CENTER SC
Entity Type:Organization
Organization Name:GANZ ALLERGY & ASTHMA CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-485-8640
Mailing Address - Street 1:1515 S GREENBAY RD
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4409
Mailing Address - Country:US
Mailing Address - Phone:262-884-6080
Mailing Address - Fax:262-884-6090
Practice Address - Street 1:1515 S GREENBAY RD
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4409
Practice Address - Country:US
Practice Address - Phone:262-884-6080
Practice Address - Fax:262-884-6090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty