Provider Demographics
NPI:1073015756
Name:DEVANG V GANDHI MD SC
Entity Type:Organization
Organization Name:DEVANG V GANDHI MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEVANG
Authorized Official - Middle Name:V
Authorized Official - Last Name:GANDHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-442-9166
Mailing Address - Street 1:PO BOX 931
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-0931
Mailing Address - Country:US
Mailing Address - Phone:414-427-7820
Mailing Address - Fax:414-427-7824
Practice Address - Street 1:6030 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2118
Practice Address - Country:US
Practice Address - Phone:414-442-9166
Practice Address - Fax:414-442-9168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty