Provider Demographics
NPI:1417994013
Name:GANDHI, BHAVESH R (MD)
Entity Type:Individual
Prefix:
First Name:BHAVESH
Middle Name:R
Last Name:GANDHI
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 1:1051 ESSINGTON RD STE 290
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-2842
Mailing Address - Country:US
Mailing Address - Phone:815-773-7827
Mailing Address - Fax:815-838-2656
Practice Address - Street 1:1051 ESSINGTON RD STE 290
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2842
Practice Address - Country:US
Practice Address - Phone:815-773-7827
Practice Address - Fax:152-548-4428
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-120708207Q00000X
WI49061207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036120708Medicaid
567500Medicare PIN
IL036120708Medicaid