Provider Demographics
NPI:1356399257
Name:GANZ, MICHAEL BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRUCE
Last Name:GANZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 12TH AVE N
Mailing Address - Street 2:STE 400E
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7514
Mailing Address - Country:US
Mailing Address - Phone:406-237-8500
Mailing Address - Fax:
Practice Address - Street 1:2900 12TH AVE N
Practice Address - Street 2:SUITE 160W
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7506
Practice Address - Country:US
Practice Address - Phone:406-237-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062000207R00000X, 207RN0300X
MT24610207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0844108Medicaid
MTM011005248Medicare PIN
F53266Medicare UPIN
OH0729256Medicare PIN
OH0729254Medicare PIN