Provider Demographics
NPI:1659320950
Name:GANDHI, ROMAL I (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMAL
Middle Name:I
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 1:12251 S. 80TH AVENUE
Mailing Address - Street 2:MED STAFF OFFICE SUITE 1630
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463
Mailing Address - Country:US
Mailing Address - Phone:708-923-5173
Mailing Address - Fax:708-923-5018
Practice Address - Street 1:12251 S. 80TH AVENUE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:708-923-5869
Practice Address - Fax:708-923-5859
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-109071207R00000X
IL036.109071208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF40081751OtherMEDICARE PTAN
IL036109071Medicaid
086381OtherHEALTH ALLIANCE
IL036109071Medicaid