Provider Demographics
NPI:1689019101
Name:GANESHAN, SENTHILRAJ (MD ,MPH)
Entity type:Individual
Prefix:
First Name:SENTHILRAJ
Middle Name:
Last Name:GANESHAN
Suffix:
Gender:M
Credentials:MD ,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5228
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:3514 21ST ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1210
Practice Address - Country:US
Practice Address - Phone:806-725-1801
Practice Address - Fax:806-723-7535
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT1365207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology