Provider Demographics
NPI:1912004458
Name:GANDHI, DIVYAKANT B (MD)
Entity Type:Individual
Prefix:
First Name:DIVYAKANT
Middle Name:B
Last Name:GANDHI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:405 W GREENLAWN AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-2898
Mailing Address - Country:US
Mailing Address - Phone:517-483-4867
Mailing Address - Fax:517-483-4861
Practice Address - Street 1:405 W GREENLAWN AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-2898
Practice Address - Country:US
Practice Address - Phone:517-483-4867
Practice Address - Fax:517-483-4861
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2020-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301061777208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI330C313780OtherBLUE PREFERRED PLUS
MI1018866OtherMCLAREN HEALTH PLAN
MI1800007OtherPHYSICIAN HEALTH PLAN
MI4840090Medicaid
MI1018866OtherHEALTH ADVANTAGE NETWORK
MI330C313780OtherCOMMUNITY BLUE
MI330C313780OtherBLUE CROSS COMMUNITY BLUE
MI330C313780OtherBLUE CROSS BLUE SHIELD
MI330C313780OtherBLUE PREFERRED PLUS
MI1018866OtherMCLAREN HEALTH PLAN
MI330C313780OtherBLUE CROSS BLUE SHIELD