Provider Demographics
NPI:1205861937
Name:GANDHI, ASHA (MDSC)
Entity Type:Individual
Prefix:MRS
First Name:ASHA
Middle Name:
Last Name:GANDHI
Suffix:
Gender:F
Credentials:MDSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 GREENLEAF AVE STE F
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60085-5701
Mailing Address - Country:US
Mailing Address - Phone:847-406-3340
Mailing Address - Fax:847-406-3345
Practice Address - Street 1:351 GREENLEAF AVE STE F
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:IL
Practice Address - Zip Code:60085-5701
Practice Address - Country:US
Practice Address - Phone:847-406-3340
Practice Address - Fax:847-406-3345
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051633207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051633Medicaid
IL036051633Medicaid