Provider Demographics
NPI:1629123377
Name:GANDHI, KIRAN R (MD)
Entity Type:Individual
Prefix:
First Name:KIRAN
Middle Name:R
Last Name:GANDHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9532 MINNICK AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-9012
Mailing Address - Country:US
Mailing Address - Phone:708-529-3027
Mailing Address - Fax:708-529-3657
Practice Address - Street 1:2701 W 68TH ST
Practice Address - Street 2:FLOOR 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-1813
Practice Address - Country:US
Practice Address - Phone:773-884-9000
Practice Address - Fax:708-423-2991
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066641208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066641Medicaid
IL610439700OtherUS DEPT OF LABOR
IL1619540OtherBCBS PROVIDER ID
IL250004156OtherRAILROAD MEDICARE
ILF300255600Medicare PIN
IL250004156OtherRAILROAD MEDICARE
ILD16718Medicare UPIN
ILL29646Medicare PIN