Provider Demographics
NPI:1497865216
Name:GANDHI, MEHUL VASANTRAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHUL
Middle Name:VASANTRAY
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 1:3277 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2512
Mailing Address - Country:US
Mailing Address - Phone:720-274-0341
Mailing Address - Fax:720-274-0367
Practice Address - Street 1:3277 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2512
Practice Address - Country:US
Practice Address - Phone:720-274-0341
Practice Address - Fax:720-274-0367
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML20008565207R00000X
IL036123842207R00000X
CO52064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58404040Medicaid
CO023325OtherKAISER COMMERCIAL NUMBER
CO273371YK5YMedicare PIN
CO023325OtherKAISER COMMERCIAL NUMBER