Provider Demographics
NPI:1003995689
Name:GANDHI, RAVINDER (MD)
Entity Type:Individual
Prefix:
First Name:RAVINDER
Middle Name:
Last Name:GANDHI
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 1:2025 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-2312
Mailing Address - Country:US
Mailing Address - Phone:734-281-3080
Mailing Address - Fax:734-281-8815
Practice Address - Street 1:2025 FORD AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-2312
Practice Address - Country:US
Practice Address - Phone:734-281-3080
Practice Address - Fax:734-281-8815
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067153207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP30500001Medicare PIN
MIY53539Medicare UPIN