Provider Demographics
NPI:1780635318
Name:GANDHI, NEELAM R (MD)
Entity Type:Individual
Prefix:
First Name:NEELAM
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 - Credentials:
Mailing Address - Street 1:33 W HIGGINS RD
Mailing Address - Street 2:STE 800
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9136
Mailing Address - Country:US
Mailing Address - Phone:815-477-0300
Mailing Address - Fax:815-477-0301
Practice Address - Street 1:260 E CONGRESS PKWY STE A
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014
Practice Address - Country:US
Practice Address - Phone:815-477-0300
Practice Address - Fax:815-477-0301
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036106464207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106464OtherSTATE LICENSE
IL036106464Medicaid
ILK01292Medicare ID - Type Unspecified
ILH75700Medicare UPIN