Provider Demographics
NPI:1013936905
Name:GANDHI, HETAL N (MD)
Entity Type:Individual
Prefix:
First Name:HETAL
Middle Name:N
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 1:7077 HIGHWAY 6 N
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2505
Mailing Address - Country:US
Mailing Address - Phone:832-937-5905
Mailing Address - Fax:
Practice Address - Street 1:7077 HIGHWAY 6 N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2505
Practice Address - Country:US
Practice Address - Phone:832-937-5905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240240207Q00000X
IN01061939A207Q00000X
TXN5064207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1231121OtherCHA
7809815OtherAETNA
TN-0107OtherJOHN DEERE HEALTH
VA238422OtherANTHEM BLUE SHIELD
VAC09011OtherTRAILBLAZER GROUP NUMBER
VA010309832Medicaid
TXN5064OtherTEXAS MEDICAL BOARD
VA011402D11OtherTRAILBLAZER
1231121OtherCHA