Provider Demographics
NPI:1255986055
Name:SANDHU, GAGANDEEP (DPM)
Entity type:Individual
Prefix:
First Name:GAGANDEEP
Middle Name:
Last Name:SANDHU
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5607
Mailing Address - Country:US
Mailing Address - Phone:312-612-5000
Mailing Address - Fax:312-612-5000
Practice Address - Street 1:225 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-5607
Practice Address - Country:US
Practice Address - Phone:312-612-5000
Practice Address - Fax:312-612-5000
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC007049213ES0103X
IL016005992213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery