Provider Demographics
NPI:1194840918
Name:GANDHARI, SUJIT REDDY (MD)
Entity Type:Individual
Prefix:
First Name:SUJIT
Middle Name:REDDY
Last Name:GANDHARI
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 1:5800 FOXRIDGE DR
Mailing Address - Street 2:STE 240
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2347
Mailing Address - Country:US
Mailing Address - Phone:913-362-5434
Mailing Address - Fax:
Practice Address - Street 1:5800 FOXRIDGE DR
Practice Address - Street 2:STE 240
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-2347
Practice Address - Country:US
Practice Address - Phone:913-362-5434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT183322207R00000X
MO20090063022085N0904X
TXBP10044814390200000X
KS04-362432085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO152360133Medicare UPIN