Provider Demographics
NPI:1164525499
Name:GANDHI, HARIVADAN K (MD)
Entity Type:Individual
Prefix:
First Name:HARIVADAN
Middle Name:K
Last Name:GANDHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:143 SILO RIDGE ROAD N
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467
Mailing Address - Country:US
Mailing Address - Phone:773-488-7744
Mailing Address - Fax:773-488-3669
Practice Address - Street 1:7906 S CRANDON AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-1146
Practice Address - Country:US
Practice Address - Phone:773-488-7744
Practice Address - Fax:773-488-3669
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2023-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036072781208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072781Medicaid
IL036072781Medicaid