Provider Demographics
NPI:1629149653
Name:GANDHI, KAVITHA (MD)
Entity Type:Individual
Prefix:
First Name:KAVITHA
Middle Name:
Last Name:GANDHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 S. GREENLEAF
Mailing Address - Street 2:SUITE E
Mailing Address - City:PARK CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60085
Mailing Address - Country:US
Mailing Address - Phone:847-680-7100
Mailing Address - Fax:847-406-3345
Practice Address - Street 1:351 S. GREENLEAF
Practice Address - Street 2:SUITE E
Practice Address - City:PARK CITY
Practice Address - State:IL
Practice Address - Zip Code:60085
Practice Address - Country:US
Practice Address - Phone:847-680-7100
Practice Address - Fax:847-406-3345
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336-067198207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212202Medicare ID - Type Unspecified
ILH74580Medicare UPIN