Provider Demographics
NPI:1821275082
Name:GANDE, LALITH KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:LALITH KUMAR
Middle Name:
Last Name:GANDE
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:PO BOX 20610
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277-0610
Mailing Address - Country:US
Mailing Address - Phone:833-584-1347
Mailing Address - Fax:210-695-7714
Practice Address - Street 1:7525 E BROADWAY RD STE 9
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-1156
Practice Address - Country:US
Practice Address - Phone:480-981-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-050675207R00000X
IL036121690207R00000X
AZ42150207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine