Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 35.048491 | OH |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 35.048491 | OH |
NPI | 1730230376 |
---|---|
Provider Name | Dann William Ganzhorn |
First Address | Cleveland, OH 44110-2602 |
Second Address | Cleveland, OH 44110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
35.048491 | MEDICAL LICENSE (01) | OH |
B22865 | (02) | |
BG0877590 | DEA (01) | OH |