Provider Demographics
NPI:1073140513
Name:GANDHI, GRISHMA V
Entity Type:Individual
Prefix:
First Name:GRISHMA
Middle Name:V
Last Name:GANDHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13100 W YORKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:BEACH PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60083-3020
Mailing Address - Country:US
Mailing Address - Phone:630-877-9003
Mailing Address - Fax:
Practice Address - Street 1:13100 W YORKSHIRE LN
Practice Address - Street 2:
Practice Address - City:BEACH PARK
Practice Address - State:IL
Practice Address - Zip Code:60083-3020
Practice Address - Country:US
Practice Address - Phone:630-877-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019753363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily