Provider Demographics
NPI:1821149238
Name:GANDHI, SANJAY (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:
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 1:351 GREENLEAF AVE STE E
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60085-5701
Mailing Address - Country:US
Mailing Address - Phone:847-234-1100
Mailing Address - Fax:847-775-0703
Practice Address - Street 1:351 GREENLEAF AVE STE E
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:IL
Practice Address - Zip Code:60085-5701
Practice Address - Country:US
Practice Address - Phone:847-234-1100
Practice Address - Fax:847-775-0703
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101308207VG0400X, 208800000X
IL036-101308207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH42764Medicare UPIN
IL211179Medicare ID - Type Unspecified