Provider Demographics
NPI:1942481940
Name:GANDHI, MONA YOGESH (MD)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:YOGESH
Last Name:GANDHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1295
Mailing Address - Country:US
Mailing Address - Phone:630-315-6500
Mailing Address - Fax:
Practice Address - Street 1:2900 FOXFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:ST. CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174
Practice Address - Country:US
Practice Address - Phone:630-315-6500
Practice Address - Fax:630-315-6519
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-18
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036134857207R00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036134857Medicaid
ILF400463345OtherMEDICARE INDIVIDUAL
IL206147OtherMEDICARE GROUP