Constance M. Ganapes, M.D.
Individual provider Active NPI Internal Medicine Physician · Milwaukee, WI
NPI 1063405751 · NPPES record last updated Aug 25, 2011
Key facts
- NPI
- 1063405751
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 23426 (WI)
- Practice address
- 2500 W Layton Ave
Suite 250
Milwaukee, WI 53221-5420 - Phone
- (414) 282-2006
- Fax
- (414) 281-8704
- NPI assigned
- Aug 26, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080911000097 | WI | Practitioner - Internal Medicine | 8921911629 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23426 | WI | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Commonwealth Medical Group, LLC | Internal Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 23426 | WI | Yes |
Addresses
Primary practice location
2500 W Layton Ave
Suite 250
Milwaukee, WI 53221-5420
Mailing address
2500 W Layton Ave
Suite 250
Milwaukee, WI 53221-5420
Phone (414) 282-2006
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30385300 | Medicaid | WI |
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- Ramsha Faatima Gandam
- Marisol Gandee
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All providers in Milwaukee, WI · Internal Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.