Provider Demographics
NPI:1992191993
Name:GANDHI, JENIL (MD)
Entity Type:Individual
Prefix:DR
First Name:JENIL
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 1:1101 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1863
Mailing Address - Country:US
Mailing Address - Phone:248-601-4805
Mailing Address - Fax:
Practice Address - Street 1:9999 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:BRIDGMAN
Practice Address - State:MI
Practice Address - Zip Code:49106
Practice Address - Country:US
Practice Address - Phone:319-671-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301107251207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine