Provider Demographics
NPI:1275880726
Name:GANDHI, NAISHALKUMAR B (MD)
Entity Type:Individual
Prefix:
First Name:NAISHALKUMAR
Middle Name:B
Last Name:GANDHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4425 N PORT WASHINGTON RD
Mailing Address - Street 2:CLINIC CREDENTIALING
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2323 N LAKE DRIVE
Practice Address - Street 2:COLUMBIA ST. MARY'S MILWAUKEE-INPATIENT MEDICINE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4507
Practice Address - Country:US
Practice Address - Phone:414-270-4932
Practice Address - Fax:414-291-5195
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2016-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI62307207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine