Provider Demographics
NPI:1356585053
Name:NATALIE GANCERES MD PA
Entity type:Organization
Organization Name:NATALIE GANCERES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GANCERES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-488-8926
Mailing Address - Street 1:255 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2218
Mailing Address - Country:US
Mailing Address - Phone:517-787-6440
Mailing Address - Fax:517-787-4146
Practice Address - Street 1:6757 ARAPAHO
Practice Address - Street 2:SUITE 711, PMB 335
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4073
Practice Address - Country:US
Practice Address - Phone:972-488-8926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty